Lucky White Rabbit Numero Dos

Last time I posted a picture of a white rabbit on my blog I had to go looking for one. This one just fell into my lap. Well, kind of. I'd explain but I can't. Let's just say I got to spend the evening doing physical exams on animals that were not patients at Cornell's hospital or part of the low-income clinic and leave it at that.

If that sounds scintillating, then you'll probably drool over my plans for tomorrow evening-- practicing suturing! As anyone who has had to learn to suture knows, it's not nearly as easy as it looks. I've actually sutured live animals before-- it's allowed for licensed technicians to suture skin under the practice act in California. I'm hoping that if I get in a good review tomorrow night then the veterinarians will let me suture on the shifts I picked up over winter break.

Did you notice my hair cut? I can't decide if I like it-- short is easy and my motto is no muss, no fuss, but my identity is all wrapped up in having long hair... A lot of my classmates have complimented me on the new look, which is nice. Although several people think it makes me look younger!&($%@

One more funny thing-- the car I parked next to in the vet school parking lot this morning had a bumper sticker that said, "Ithaca, 10 square miles surrounded by reality." That made me laugh. EB and D always used to say that Northampton was La-La land. I think Ithaca is even more out there. At least someone else had a similar thought-- enough so to make a bumper sticker.

Fun For The Whole Family

That's me with EB, D and a very squirmy Ianite over Thanksgiving vacation. And a photo of Ian and his dad in which you can actually see Ian:


Here Ian is walking around with a block, showing off one of many pieces of canine-themed clothing I purchased for him back in California.


I wish I could have another two weeks of vacation. It was great to see my parents, EB, D, Ian (he's a real little person now, no more baby) and their finally renovated new old house.

It was also great to get out of Ithaca even if just for a few days. The sun is so much brighter in North Carolina! (Just before I left I began using a light box to try to make up for my sunlight deficit so hopefully that will help me continue to feel good now that I'm back).

Not to mention that I made out like a bandit-- I got my mom and dad each to buy me a piece of warm winter clothing as a holiday/early birthday present and my mom also gave me a book that I love even though I am only a few pages into it-- Something for the Pain: Compassion and Burnout in the ER by Paul Austin. It's tales from human emergency medicine-- hauntingly similar to veterinary medicine in some respects and completely different in other ways. I'm riveted.

Thanks everyone!

Round One: I Advance

I got back my final exam yesterday, but waited to open it until this morning. People were opening theirs in the hallway at school and there was a lot of talking about grades and how people did and how they felt about how they did. I don't think there is anything wrong with this sort of thing. But I was certain I did badly and didn't want to show my emotions at school. Then, last night, before going to bed, I was worried it would keep me from falling asleep if I looked.

Needless to say, my classmates and roommate were shocked by my self-restraint. Last night as I sat studying at my desk, my roommate asked inredulously, "You mean you don't know what grade you got yet?" And I said calmly, "No, I haven't looked."

This morning I woke up with butterflies in my stomach. I ate my cereal, fed my cats, and took out the thick manila envelope.

I was shocked. I got exactly the grade I was aiming for. Not an A, but a very respectable grade at Cornell. The class average was a C, and I wanted to be above that.

I have no idea how they graded as I am certain that my raw points should not add up to my grade, but I'm grateful.

I think I'm most proud of my laboratory section. There are many people who said they scored roughly 50% on their lab portion. It was incredibly difficult. People were crying during it. I started in the hardest section of all and was just trying not to panic for the first hour. Even now, people are talking about how they left that section almost entirely blank. Well, I struggled to put down an answer for everything, even when I had no idea what I was looking at, but I really felt like it threw me for the rest of the exam and like I was so shaken I could barely think. But I did perform well under pressure (my lab % was 75%, pretty amazing).

In other news, I've been feeling really sad lately. Depressed. It could have something to do with daylight savings and be related to seasonal affective disorder. There's other things going on in my life that have made me feel sad, but I don't want to go into them here.

I'm now solidly into block II, Cell Biology and Genetics. I like basic science a lot. We're currently studying cell signaling, which is super complex and kind of confusing but I am trying to focus on the major themes. When we started the section on cell-signaling this week our professor put up a slide of a painting by Hieronymous Bosch and said we might feel like we've entered one of his paintings and arrived in a very strange world filled with minutiae. He then put up another slide by Bosch, of Saint Anthony being tortured, and said that we might even feel like our professors are trying to torture us just like Saint Anthony was suffering in the painting. Kind of bizarre. I know the pathologist I worked for over the summer is famous for saying to students, "This isn't meant to be mental torture." Maybe this guy thinks the opposite. I certainly hope our final is not as brutal as the one I just got back, I don't want to take another exam that hard for a long time!

East Coast Medicine

There are certain diseases and problems that are more common in certain regions of the country. California is famous for foxtails. I've seen them in just about every place imaginable, including in the urethra of the penis of a 12 year old blocked cat (that was an unusual blocked cat case just to prove you never quite know what to expect even with something you see all the time).

In the Bay area I also saw a lot of snail bait toxicity, specifically metaldehyde toxicity. And quite a bit of hyperthermia (the only time we ever closed the doors to the emergency clinic was on a weekend where it stayed over 115F and we literally had no more room for bodies, dead or alive, pretty horrific).

Things on the East coast are a little different. For example, I'd never seen a dog with a face full of porcupine quills before I came here (the paws were covered too).

Today I went to an emergency medicine lunch lecture titled "The Perils Of Winter." The speaker covered hypothermia, ethylene glycol toxicity and house fire (for reasons I do not completely understand, house fires are more common in the winter).

I guess winter emergency medicine will be a whole new brand of medicine for me. I haven't seen an ethylene glycol toxicity in quite awhile, California had the good sense to mandate that manufacturers add a bittering agent to any product sold in the state. In fact, a similar proposal is currently on the table nationally, HR 615, but apparently only Republicans support it so far????? Here's another article I found on the subject, "With antifreeze, bitter is better." It seems crazy to me that such legislation has yet to be passed when ethylene glycol toxicity has killed children, not just pets, who ingested even tiny amounts of the sweet substance. When I have time maybe I'll write to my representative and voice my opinion on the matter. I encourage you to do the same if you are at all so inclined.

In other news, I've started block 2. Cell biology. Lots of my classmates are whining about this class but since I love basic science I am enjoying the material.

I'm still learning lots about cows, and other species, but not allowed to post any pictures.

And tonight I went to the low-income clinic again and saw some interesting cases but can't write about the details here. It is nerve-wracking seeing a patient with no one to follow you up. I feel like I must be missing something important every time I do a physical exam and can only hope that I'm not missing anything important.

And the rumor is that if the administration hasn't contacted you yet then you passed your exam and are not on academic probation. I don't totally believe it-- and I won't till I actually have my exam back, but every day that passes works in my favor and means it is more likely I was in the passing range.

Survive And Advance

One of the second year vet students likened vet school to an NCAA tournament. He said, "The goal is to survive and advance [to the next round]. How much you win by does not matter."

I've achieved step one-- I survived block I, and all five days of my final exams. Now I have to wait two weeks to see if I advance to the next round. At this point, I don't care if I get a D or an A as long as I pass. Of course, it is preferable _not_ to be on academic probation, but the end result is the same if I get a D or an A-- I advance.

I've posted the picture of me with a white rabbit because I don't want to be outdone by my sister. She thinks she can keep up with me by posting some photos of her and her daughter with a plastic cow. So I had to find a white rabbit (his name is Gideon) to prove I can keep up with her photos of my niece with a white rabbit!

Now, let's hope I can pull a passing grade in this class just like I pulled this white rabbit out of a hat!

One Down, Four To Go

I got one exam out of the way today in my five day marathon of finals. It was the written part for the clinical portion of my course, called Veterinarians and Society or something rather silly sounding. Basically, we begin to practice physical exams on a variety of species, gain experience working with dogs, cats, cows, horses, pigs, sheep, goats, chickens, rabbits-- you name it, and learn a little bit about various sundry other topics from practicing doing ultrasounds to practicing a cranial drawer.

It wasn't too bad, which is good, as I didn't expect it to be. It wasn't exactly easy either and I definitely need to work on some things before my oral exam/clinical skills test on Thursday morning.

I studied this evening with a classmate, working through last year's final that our professors gave us access to online. It was HARD! It made me a little nervous about passing, which is something I haven't worried about too much since my midterm.

I had to laugh about some things though. We reminisced about our fondest memories from the semester. Mine is definitely from gross anatomy lab when we were dissecting the inguinal canal (in the female the external pudendal artery and some fat passes through the inguinal canal, and there is a superficial inguinal lymph node externally that drains through the inguinal canal; in the male the testicular artery and vein, ductus deferens and lymphatics pass through the inguinal canal). I-- along with the rest of the class-- was very confused about the vaginal ring, basically an outpocketing of peritoneum that wraps around the structures in the inguinal canal. I was having an argument with my gross lab partner about whether anything goes through the vaginal ring. She adamantly insisted nothing passed through the vaginal ring. This did not appear to be the case to me on gross inspection (I have since learned what one thinks one sees can actually be very deceiving) and so I went to ask one of our professors circulating in the gross lab about this. The professor I addressed is a very famous, old school anatomist. In the words of another very famous professor, 'He is a big muckety-muck.' (I like that phrase). The following conversation took place:

Me: 'Dr., what stuff goes through the vaginal ring?'
Dr. Big Muckety-Muck, exploding, 'STUFF!!! There is NO "STUFF" in anatomy. NEVER say STUFF. AND NOTHING GOES THROUGH THE VAGINAL RING.' (spitting in my face with his vehemently delivered reply)

I think for the rest of my life that dramatic exchange will be a memory that stays with me. And I will never forget that nothing goes through the vaginal ring, it is the wrapping that forms the vaginal tunic for the testes (quite suitable as vagina means sheath).

A few days later classmates in my tutor group were discussing what structures passed through the vaginal ring. I told them nothing, but they didn't believe me. But I was right and for once I was dead certain of it.

I think I will pass on a few wise words of advice to next year's class. Among them, use Konig Liebich's veterinary anatomy text for the larynx and use Pasquini's anatomy text for the reproductive system, in particular, a careful study of Pasquini's image of the spermatic cord and vaginal tunic will head off the massive confusion experienced by my class. Or perhaps I shouldn't pass on these words of wisdom as they will not get to experience the fun I had laughing over these trials and tribulations.

And now, back to histology and then more reproductive anatomy.

After all, I have to know my 'stuff' :)

Addendum: It occurs to me that what I wrote might come off as seeming like I don't like Dr. Muckety-Muck. Rather to the contrary. He is very helpful, kind and totally dedicated to teaching. However, it took me some time to realize that he is also rather dramatic and to not be intimidated by his style. And, as my study partner commented, 'He would never say stuff because he has a Latin term for EVERYTHING!' So true. Only in vet school can one appreciate the usefulness of knowing every bump on every animals' body and that is why Dr. Muckety-Muck is so amazing.

You Know Finals Are Near When...

1. You sleep through your alarm and in your haste to get out the door on time, you put your shirt on backwards and don't realize it until after lunch. (That was last Friday).
2. You sleep through your alarm again on Monday, even after sleeping in all weekend (perhaps because you are so used to getting up at 6 am that you don't ever sleep past 8 am even on weekends).
3. You have no milk so you have your granola cereal with water (Monday and Tuesday).
4. You eat all the buffalo stew you made and start in on the frozen dinners (Wednesday).
5. You forget/mis-remember a good friend's birthday (sorry!)
6. You don't understand your own cryptic notes. I looked at something I had scribbled in the margins during a case presentation-- LR6SO4-- and could not figure out what it referred to. It had once made perfect sense to me, so much so that I wondered why our ophthalmology professor had said it was the last thing her resident said to her before walking out the door to take his boards. I remember thinking it was so obvious that no one would ever need a mnemonic to remember it. After much searching, it stands for the extraocular muscle innervation. Cranial nerve VI (abducens nerve) innervates the lateral rectus and retractor bulbi. Cranial nerve IV (trochlear nerve) innervates the dorsal oblique (superior oblique). Cranial nerve III (oculomotor nerve) does everything else. And so LR6 stands for lateral rectus muscle cranial nerve VI, SO4 for superior (dorsal) oblique muscle cranial nerve IV. All this to help me try to remember on tomorrow's test that abnormal deviation in the position of the globe of the eye can look like ventrolateral strabismus (lesion involving oculomotor CN III), medial strabismus (lesion involving abducens CN VI) or rotation of the globe (trochlear CN IV), which can be difficult to see if the pupil is round because the deviation in the position of an elongated, ellipsoid pupil is the easiest way to assess whether the glove of the eye is rotated (otherwise one is forced to look at the position of the retinal blood vessels on the back of the eye, the fundus). All that just for the eyes! And cranial nerves are just a small part of a neurological exam, there is so much more to the nervous system and so much more to just a basic physical exam (especially when one considers species ranging from chickens to alpacas to cows)!