Fall 2016

From Classroom to Clinic

We asked five students from Cummings School’s Class of 2017 to tell us about the excitement, anxiety and pride of beginning their clinical rotations

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Photo: Thinkstock, Portraits: Jake Belcher

TURKEY SURPRISE

By Adam Shoelson 

The entry to the emergency room at Cummings School of Veterinary Medicine makes anonymity almost impossible—the huge automatic sliding door seems to announce one’s presence, like curtains opening on a stage. And if you’re a vet student on rotations, you’re expected to get down to business immediately. An owner is on the phone, concerned about a reaction her pet is having to a drug—comfort her. A dog that has got into the trash and begun vomiting is in the waiting room—triage him. A feral cat has been prepared for neutering—glove up and grab your scalpel. It is fast-paced and unpredictable.

I loved the classroom portion of vet school. But it was routine. While I was studying for my last final in small animal medicine, I reflected that after hours upon hours of lectures and exams, even the most interesting subjects can lose their luster. I needed to start my clinical rotations.

And when I did, I soon got the boost I was looking for. My first night in the ER, I emerged from the break room to find that a sick turkey had arrived, with symptoms including bloody diarrhea. I was told to get a history. I thought back to our exotics and zoo med classes—what questions do we ask poultry owners? I didn’t know, and that was exciting.

Showing up prepared for vomiting dogs and obstructed cats, and instead getting a turkey with the runs may not be everyone’s idea of a great job experience.

I took the history as best I could, and then was asked to do a physical exam. Again, I thought back to our classes. It was late. I couldn’t recall how to properly handle a turkey. If I restrained her wrong, would I hurt her? Could she hurt me? Also, I had no clue what the normal vital signs for turkeys are. I could barely come up with three or four diseases that turkeys are susceptible to, let alone specific conditions that might be causing bloody diarrhea. And again, all of that was exciting.

Fortunately, I got some help. The clinician on the case walked me through a physical exam. A technician in the ICU showed me how to restrain, catheterize and give a pill to the large bird. Together, we all came up with a treatment plan.

More to the point, though, my wild night confirmed that veterinary medicine is the right choice for me. Showing up prepared for vomiting dogs and obstructed cats, and instead getting a turkey with the runs may not be everyone’s idea of a great job experience, but it’s the sort of thing I thrive on. As clinics have continued, I’ve tackled more cases outside my comfort zone. My schedule is inconsistent. I am sleep deprived. My own dog misses me and thinks I smell strange when I come home from the hospital. There is still a background nervousness that pops up whenever I enter an exam room or begin a procedure. But I wouldn’t have it any other way. I can’t wait to see what lies ahead.


 

A PATIENT OF ONE’S OWN

By Gabi Villanueva 

On the Monday of my second week at the Tufts Wildlife Clinic, I was called in at 9 p.m. A woman had found a grounded blue jay. Walking into the clinic soon afterward, bird in box, I was excited to take this case on my own.

Twenty minutes later, the “grounded” blue jay had escaped my grasp not once or twice, but three times, on each occasion flying—well, might I add—around the room before I could catch him. “OK, Mr. Blue Jay, third time’s the charm,” I told him as I stood cupping him in a towel between my hands. After maneuvering a physical exam with no more escapes, I discovered a wound on the jay’s back and triumphantly reported my findings to the intern on the phone.

“All right, what do you want to do?” she replied. At this moment it hit me: I was no longer a work-study assistant at the clinic, as I had been for years. I was a fourth-year vet student, and this little bird was my patient. I would be in charge of the treatment plan. I would be the go-to person if problems arose.

The “grounded” blue jay had escaped my grasp not once or twice, but three times.

Of more immediate concern, it would be up to me alone to administer fluids and buprenorphine for pain that night. For a solid 10 minutes, the blue jay, surely frustrated he couldn’t get away, had no trouble using his nails—or should I say minitalons—to keep me from poking him. Having everything ready and knowing exactly what to do but not being able to do it because of a feisty 80-gram bird definitely falls into the “one-of-those-humbling-vet-school-experiences” category.

An hour after beginning my adventure, I finally placed the exhausted but comfortable blue jay in an oxygen tank for the night. When I came back the next morning, I only had one thought in my mind: “Please let Mr. Blue Jay still be alive.” Sure enough, he was, and he was ready for round two. I walked by the room where one of the clinicians was examining him just in time to see him wriggle his way out of her hands.

My struggles with that blue jay marked the beginning of my transition from the classroom, filled with hypothetical cases, to the actual practice of veterinary medicine. I spent the rest of the week assuming more of a “these-are-my-patients” perspective. Of course, there was and still is an army of experienced clinicians and staff right behind me—after all, I’m just getting my feet wet here. Still, I’m more aware than ever that when I’m on clinics I’m the first line of care for patients, and that alone changes one’s perspective. At the wildlife clinic, I approached daily treatments with a greater sense of purpose, euthanasia hit closer to home, and when, like Mr. Blue Jay, patients improved, or were even released, the experience was that much sweeter.


 

THE BEST, KINDEST WORK

By Jessica Mintz 

It’s 7 a.m. on my third day of clinical rotations. I’m at Tufts at Tech, a community medicine clinic in Worcester, Massachusetts, and my white coat is heavy. This is not a metaphor. It is literally heavy, because I have crammed everything I could think of into the pockets: pens, Sharpies, three different notebooks, bandage scissors, iPhone, pen light, energy bars and two reference books that I pray will help me figure out what’s wrong with my patients. I loop my stethoscope around my neck and head to my first appointment.

One day, as I was brainstorming my next move in journalism, I found myself contemplating vet school.

Many seemingly random events have come together to pull me into this work for which I’ve geared up so thoroughly, not the least of which was the arrival of Pooka, a Rhodesian Ridgeback mix with a passion for wildlife. I adopted Pooka in Seattle, midway through my first career as a technology reporter. One day she took herself on a walk (no doubt looking for squirrels) and was hit by a car. The time I spent afterward with emergency veterinarians, surgeons and rehab experts to help her recover sparked something for me. One day, as I was brainstorming my next move in journalism, I found myself contemplating vet school, and out of my pen came the phrase “the opportunity to practice tangible kindness every day.”

The promise of more fulfilling work offset the sadness of giving up my identity as a journalist and my status as a professional, the shock of returning to the college classroom as a thirty-something, not to mention the challenges of vet school itself. Now, suddenly, that’s all over, and I am wearing this white coat and walking into this exam room.

There, a woman and her son-in-law are cradling a tiny dog in a blanket. The dog has been sick for weeks, and the family believes it’s time to say goodbye. I listen. Of course, my impulse is to try to save the patient. Surely, fluids and insulin and nutrition would help! But the medical director slows me down. I take a breath. We place a catheter. I talk with the woman about what to expect at the end, and tell her how sorry I am, and how much I know she has done for this tiny creature.

This is my first euthanasia. It’s also my first chance to allay a fear that’s been haunting me as clinics approached: That I will open my mouth to speak and not find the voice of the veterinarian I hope to be—authoritative but empathetic, science-driven yet able to explain things in ordinary terms. A veterinarian who, like those who cared for Pooka and all the others I’ve worked with since, “practice tangible kindness every day.”

To my relief, something clicks in that exam room. I do the best, kindest work I could do. And more than on any day as a writer, I am at home.


 

;THE THRILL OF COMPETENCE

By Alexa Ortiz 

The most annoying thing about clinics is that right when you finally feel confident in your work, you have to switch rotations. The first time that happened for me I’d just gotten through an anesthesia rotation. When it began, I was panicking whenever I was left alone in the operating room, and by the time it ended, I was calmly and independently adjusting ventilator settings during long, complex surgeries, knowing that if I made a bad decision, the patient could die.

And then suddenly I wasn’t using those skills anymore, because I was starting a large animal medicine rotation. My life revolved around adorable neonatal babies, all-night on-call shifts, rectal palpations, nose tubes, horses with abdominal upset and eight pig patients. There was also a vast amount of material to review; for example, drugs: the properties of each one, its uses, its contraindications, its mechanism of action, the diseases it treats.

You find yourself remembering forgotten details from lectures and PowerPoint slides. And you answer questions you didn’t think you could answer.

But what you discover with these jarring changes is that you can deal with them. You learn to relax, to trust your abilities and your judgment. You find yourself remembering forgotten details from lectures and PowerPoint slides. And you answer questions you didn’t think you could answer—as I did one day during rounds in large animal medicine. The doctor, who had been grilling us about medications, asked about the antibiotic enrofloxacin and noted that we had little to say about it. He was just beginning to scold us when I interrupted him mid-sentence. I did know about enrofloxacin! I had just given it to a patient the week before. I had looked up all kinds of information about it, and what was most exciting, I remembered that information.

Someday, the expertise I’m accumulating will be second nature. I’ll barely recall the fears that plagued me as I started clinics. For the moment, however, competence is a real thrill.


 

HAPPINESS UPON HAPPINESS

By Nancy Boren 

Being a parent and a vet student has not been the easiest combination. That said, I can’t imagine doing it any differently. With two young sons watching my every move and gauging my attitude toward school, I am well aware that I am a role model, and that helps keep everything in perspective. When I began classes at Cummings School, my older son was in fourth grade and my younger son was in first grade. We all had homework, and many times we did it together, although I would never finish mine until long after they had gone to bed.

Of course, clinics are an entirely different world from classes, and as excited as I was for them, I’d be lying if I said I wasn’t nervous about how they would affect my family. Much of the time, I wouldn’t even be able to predict when I’d get home. And I was worried for more basic reasons, too. After all, I had taken a long road to vet school, one that wound through the social sciences, legal work, law school and being a stay-at-home mom. As a result, it had been more than 15 years from the time I’d taken my first vet school prerequisite until this big moment—now that it was finally here, what if I wasn’t good at the actual work of veterinary medicine? As a student, I focused on small animals and lab animals—how on earth could I deal with large animal surgery as one of my first rotations?

I had taken a long road to vet school. What if I wasn’t good at the actual work of veterinary medicine?

Fortunately, my husband has taken on more responsibility at home, and we can count on some wonderful family friends to help us out in a pinch. Fortunately, too, clinics are going well for me. I like getting to know the clients. I like coming up with differential diagnoses. I like working with the animals themselves. Finally, I’ve ended up with fond memories of that dreaded rotation in large animal surgery, especially since it introduced me to Chandler, the 19-year-old miniature horse I was soon referring to as “the best patient ever.” He loves to be brushed! You can see me with him and my classmate Sylvia Kim, V17, on Cummings School’s Facebook page—check out his charming braided forelock.

But one of the best benefits of my new career is being able to share so much of what I love with the people in my life. While I’m too busy to volunteer in my sons’ classrooms as much as I used to, I still get there, and when I do, I teach the students about animal care. I talk to my husband and my sons and my sons’ friends about Chandler and other patients, like the pot-bellied pig I’ve enjoyed walking on a lead. My family is, I think, happy that I am happy—which makes me happier still.

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