An Unintended Philosophical Tangent

“The happiest people don’t have the best of everything, they just make the best of everything.”

In an effort to rise out of my slump grave, and thanks to the highly repetitive nature of the music radio stations, I discovered audiobooks. Through my new found appreciation of audio books, I’ve been listening to some of the typical cliche “Self-improvement” books. More accurately, I would call these published compilations of life improvement tips. In the last 4 weeks, I have spent roughly 90 hours of my time driving. Driving from one state to another for rotations, driving daily across congested metropolitan expanses and driving to satellite clinics. Also, I’ve got friends in far places… Collectively, these audiobooks and NPR’s This American Life podcasts have turned my road time into productive investments in myself and thus, my future. Also, the thought-provoking material keeps me distracted from the emotional rollercoaster that is city traffic. It is refreshing to learn about topics, current events and anecdotes unrelated to the medicine field.

The audiobooks got me thinking about the concept of perspective and the recurrent thought that there is more than one way to skin a cat. Even the idea of “right” vs “wrong” is ultimately a matter of perspective. I wrote about this theory on my GRE examination when given the prompt ‘While laws can be clearly defined, why is the legislation of morals such a challenge?’ Perspective and ethics, derived from personal experience, beliefs and knowledge, are unique to everyone. I’m not meaning to get on a philosophical tangent. What sparked this whole cascade of thoughts and theories was my life improvement quote of the day that greeted me at 6 AM when my alarm went off.

“The happiest people don’t have the best of everything, they just make the best of everything.”

Heine sight being what it is, the quote didn’t cross my mind during the busy day at my hometown veterinary hospital. Today was day 3 of a two-week long externship at my mixed practice. The last time I had been to this hospital, which is roughly 7 minutes from my u dad’s house, I was nine years old and my first pet was receiving his complementary post-adoption exam. I don’t remember much about the people or the hospital, but I do remember the techs having to take my cat to the back for his vaccines. I didn’t know then, but my cat would prove to be the kind of fractious patient that I nowadays dread.

The financial noose has been getting tighter these days, and the opportunity to stay with my dad while completing this externship was too great to pass on. Thankfully, the hospital was willing to take me on despite having no real history of visiting veterinary students. They have welcomed a many veterinary-curious and veterinary-hopefuls for a day of observation, but never a vet student and never for two weeks straight. So I was apprehensive the day before, but went into the clinic with an out-going and enthusiastic persona. Fake it til you make it.wpid-veterinary_memes_invisiblebikecat.jpg

And so far, I’ve been making it.

While 80% of the caseload is small animal, one James Herriot style vet sees all creatures great and small, and two of the seven doctors see small ruminants in addition to dogs and cats. Since my last visit 19 years ago, they have since moved into a new hospital and obtained a small clinic in a semi-remote town 45 minutes away. They operate the satellite clinic 3 days a week and after hearing colorful and hilarious tales about the isolated community, I had to see it for myself.

I showed up early to the main hospital, intending to carpool with a tech. After 45 minutes and waiting and no word from te tech, I offered to shuttle supplies and myself to the satellite clinic.

Enter perspective.

The clinic was converted from a house downtown and has one waiting room and one combined treatment-kennel-surgery area. The waiting room has a counter, limited technology and two waiting chairs. Poor ventilation and no air conditioning necessitates propping open the side door during the summer months. In the only space available, which just so happens to be right inside the patio door, the radiology equipment lives. Since this clinic uses film, and I mean old school film, naturally the nearby closet serves as a dark room for processing the film. And while the patio furniture serves as  a reminder that this was once someone’s residence, it also provides an avenue for street side entertainment.  The community is large enough for a gas station, town hall, subway, three taverns and various mall shops. The town is also small enough that a single blinking light is the sole traffic light within town limits. Logging set the precedence for the town’s existence 80 years ago, and while logging pride is evident town-wide, it is also sustaining itself as a community with a largely “older” generation making up the majority of the population.

After hearing all these stories about the satellite clinics clientele and the personality of the community, it should not have surprised me that at any time there was someone peering into the clinic treatment area from the street. Basically, a peanut gallery was ever present throughout the day. The chance to watch veterinary professionals wrestling dogs onto the radiology table was straight up entertainment. Even better, there was what one belligerent woman referred to as the “sweet spot” on the street where the angle was just right that someone could observe “the good stuff” or surgery. While awkward to have an audience, I was mostly glad that I couldn’t hear what onlookers were saying. Just random laughs and occasionally an overzealous comment from the “sweet spot” regulars.

One doctor, one technician and one receptionist operate the clinic. There is no in house bloodwork, no ultrasound and the medication shelf was limited in its breadth. The doctors rotate who has clinic duty, and this is likely because they all dislike it profoundly. From the moment I arrived, I liked the clinic. The atmosphere, the limited resources and diagnostics and the flavor of the community made each case that much more interesting. Critical cases would be referred to the main hospital but this lower-income area meant most clients would not opt for referral. The limitations are what made the cases interesting because they called for ingenuity and for creative (and critical) thinking.

Enter improv.

With the up-beat cases of the day, the constant challenge of coming up with affordable and practical medical approaches was a test of inginuity. I felt invigorated and these situations are very relevant to what one faces out in the field. This might be one reason why I find the thought of mobile practice so exciting and rewarding. Based on the nature of the day’s scheduled appointments, specific medications and supplies can be picked up from the main hospital en route. But without a crystal ball, we are ultimately vulnerable to what case walks through the door.

Today, the cases were steady and manageable. The cases included two kitten exams, two puppy exams, three cases of tentative flea-allergy dermatitis, one coughing dog with radiographs depicting a soft tissue mass in the thorax (we suspected a mediastinal mass or heart base tumor) and two nail trims. One of the nail trims was on a chihuahua accompanied by the owner, her mother and her boyfriend. This appointment lasted for roughly 4 hours, although the nail trim took less than one minute to complete. It was largely due to the fact that the client and company parked in the lobby’s chairs and started what could only be compared to as beauty parlor talk…for the rest of their 3 hour and 59 minute visit. This was frustrating, only because the small lobby is the size of a modest dining room and influx/outflux of people and animals means things get hectic, close-quartered and inordinately loud. Social friction also reared its ugly head when the chihuahua’s owner’s mom’s boyfriend’s neighbor came in with their cat. They must not have heeded Robert Frost’s advice that good fences make good neighbors and it quickly became apparent that their fence was something of a wreck.

The only surgery of the day was a castration, which the doctor went halvsies on with me. I was shocked when she asked if I wanted to neuter a dog. Externships are great opportunities to learn, I’d never doubt that. But there is alot of learning through observation, not necessarily hands on…so I lucked out on my extern location. The neuter was without complication, and by 4:30pm I was headed home in a pleasant mood.

I am the facilitator of my learning, and I’wpid-kiwi_20150723_020215.jpgm also learning to be the captain of my perspective. Keeping a positive outlook or frame of reference is essential for me, and is perhaps the only thing that can get me through on the perfect storm days. I’m really working on being open-minded, learning everything I can about anything, and taking all the different advice/suggestions/techniques/knowledge of other practitioners and technicians…compiling it all, and learning what works best for me and what helps me become the doctor I want to be.