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Communication 101

Mary Margaret with her goat
Mary Margaret, goat whisperer (OK, it’s not really related to the story, but it’s cute…)

I opened the door and she was right in my face, spewing endless fears about her cat dying in the back room. She was a constant stream of worry and concern, pulling at her hair and filling my ears with the sounds of escalating panic. “Can I see her?” “Is she going to die?” “I don’t know what to do; she’s never been this bad before!”

 

It was like walking into a room with the living embodiment of pure anxiety.

We sat down and I calmly talked her off the cliff long enough to have a serious conversation about the care her cat was about to receive. Yeah, not so much. As we sat, she panicked externally while I panicked internally and tried to remember how to stave off an anxiety attack long enough to get a form signed and get out of there.

This was communication training for veterinary students. It is one of the most terrifying things we face in veterinary school, and one of the best opportunities we have to get ready for life as a veterinarian.

It starts off innocently enough in first year, with actors playing clients, and students working through a simple history-taking exercise, just trying to get the information needed to assess the patient. As we moved up in the curriculum, the scenarios get more challenging, with our third year putting us in front of enraged clients, anxious clients, clients whose pets have horrible diseases, clients who are determined to criticize everything the veterinarian says or does.

After we painfully work through each scenario, we have the opportunity to discuss the scenes with our classmates and professors, as well as the actor.

We receive feedback on our active-listening skills, how empathetic we were, whether we achieved our goal for the scenario, and how the client felt and what they heard. Our classmates offer constructive criticism, and we talk through other ways it could have played out.

Watching my classmates work through their scenarios, and completing my own, has given me more confidence going into our fourth year, where we are expected to be mini-doctors and handle all those tough talks.

Any panicky clients coming through the front door? I’ve got this.

What’s in an Externship?

Mary Horse Externship
Mary Margaret takes a look into the eye of a horse that was being examined for a complicated ocular disease during her second summer externship.

What does a veterinary student do during their limited summer breaks? Anything that looks a lot like school without actually being more school, of course.

I chose to work in a few hospitals and also extern in a few hospitals. What’s an externship? Well, it’s two or more weeks of total immersion into a practice, which allows students to try and figure out if that practice or career path will be a good option for them. All fourth-year students at A&M complete somewhere between two and 12 weeks of externships at clinics all over the state and, sometimes, the world. I picked three different equine hospitals across the state and spent a few weeks this summer trying to figure out if being a horse vet is a good idea.

The first externship was still technically during breeding season and, as with most things involving babies, very little sleep was had. Every mare that came into the hospital was outfitted with an alert system so that the doctors and interns would know when she was starting to give birth. The process is pretty quick in normal horses, so when that alarm went off, it was “throw your boots on and run to the barn” and “hope you make it in time in case anything goes wrong.” The first foal delivery I was involved in decided to arrive at 4:00 in the morning. It was adorable and everything went perfectly, but it was a good reminder that horse vets (and horse vet interns, in particular) don’t really know the meaning of the word sleep between February and April. Having said that, it felt like I learned more in those few weeks than the entire previous semester.

The second externship was a whirlwind of surgery, lameness exams, and pregnancy checks. It was at an enormous hospital where each doctor is given their niche, and the sheer volume of patients they see meant that there were too many things going on for me to see them all. I generally tried to live in the operating room, as equine surgery was something I’d never really gotten a chance to see before. I saw surgeons work on colic cases, angular limb deformities, cryptorchid castrations, kissing spines, subchondral bone cysts, laryngeal hemiplegia, and on and on. In the short time I was there I was able to witness and assist with more and more diverse surgeries than I’ve ever seen in small animal practice or at school.

One day, a boarded veterinary ophthalmologist came by to take a look at a few patients with more complicated ocular disease. On a patient with unilateral glaucoma, he was able to take a good chunk of time and show the other extern and me how to do a thorough eye exam and the signs of disease in that particular horse. It was really nice to have that detailed explanation and hands-on experience before coming back to school to study equine ophthalmic diseases in the fall.

The third externship taught me more about herd health than I expected equine practitioners needed to know. Several clients owned dozens, if not hundreds, of horses, and managing them from a veterinary perspective became less about the needs of the individual horse and more about how to keep then entire group healthy. We spent an entire day driving around one property checking on different age groups of horses. Each little herd got a thorough distance exam, and those that stood out as being abnormal were inspected more closely and scheduled for diagnostics or treatments, as needed. This way problems needing medical attention were taken care of, but every individual horse did not have to have a full workup.

Every externship is different, and each of these taught me something new about being an equine practitioner. I’m still not sure if I want to be an equine vet, but now I feel like I have a good idea of what the day-to-day life involves.

Ready for a Good Day (Lessons Learned from Bubba)

Mary W.Veterinary school is hard.

If you’ve been talking to vet students or graduated veterinarians, you’ll hear this phrase pretty often. People will first congratulate you on the path you’ve chosen, and then try to warn you of its steepness. You won’t believe them, even when you’re filling out the extensive application, or prepping for the nerve-wracking interview, or just trying to get your hands on as many sick or broken animals as you can and realizing its impossible to help them all.

Well, maybe you’ll believe them a little, and steel yourself against the stress, but it won’t really sink in until that first week of vet school bowls you over and leaves you buried in the dirt. And then the next week does the same. And the next. Over and over again for four years.

As you can imagine, this takes a bit of a toll on a person. To keep our heads above the rising tide of stress, we vet students learn a couple of coping mechanisms. Maybe it’s exercise or hobbies that have nothing to do with school. Perhaps it’s something small, like setting aside all study materials at meals. Many students lean heavily on their families, friends, and partners.

But one coping strategy we all seem to pick up in the first month of school is complaining. We vent our frustrations to our classmates almost constantly. Maybe it’s a poorly written test, or a difficult skill to master, or we don’t agree with an administrative decision; the subject doesn’t really matter—we will find fault with something in this stressful experience  and will kvetch about it until we have run out of words. This strategy is so pervasive throughout school and the profession that it’s one of the strange things that draws our community closer together.

This is why Bubba stands out.

I first met Bubba working the morning shift at the ambassador desk. After a series of halfhearted “good mornings” that were responded to with a grimace and a mumbled greeting, here comes a man who looks like the sun grew legs and started walking. Big smile on his face, a spring in his step, eyes so cheerful they’ve almost disappeared, Bubba radiates joy. He greets everyone he sees with a smile, a “how’re you doing today?” and a few questions about their lives.

He seems to know something about everyone and delights in getting to know a little more every time he sees them. Just this morning he asked me about the exams I was getting ready for, and he was more than confident that I would ace them all. But what really stuck with me from talking with Bubba this morning is when he asked me if I was ready for a good day, as if the good days are all around us, just waiting to be found.

What a different perspective to have! In vet school, we condition ourselves to expect little more than stress and frustration from everyday life, that we aren’t ever truly “ready” for good days. We don’t expect to find joy in school, and, so, we don’t.

I want to say thank you to Bubba for reminding me at least once a week that there are good days to be found in vet school, if only we are ready for them to happen.

A Glimpse into the Vet School Curriculum

Mary W.As the new curriculum is implemented here at Texas A&M’s College of Veterinary Medicine, more and more courses are designed to be fully clinically relevant. For the students, this means we get to play doctor from day one, as overwhelming as that may be. Here are some examples of what my fellow second-year veterinary students and I have seen among some of our classes this semester.

“Charlie is a 6-year-old MC Boston Terrier who presented to your clinic with a one-month history of seizures that have been increasing in frequency and duration. After reviewing the following complete history and introductory blood work, write a prescription for an appropriate drug for Charlie.”

Thus begins another pharmacology lab.

My classmates are split into groups of five or so, each with a different case profile. For this lab, the groups are paired, with one acting as the emergency service and the other as the neurologists.

While every case is different, they all have seizures, as we are focusing on anti-convulsants in lecture. We will spend about half an hour combing resources and notes trying to come up with an appropriate treatment plan before going over all of the cases with the clinician who is presiding over the lab.

We discuss why certain drugs must not be given to certain patients and why one option may be marginally better than another. The clinicians also try to emphasize that sometimes there is no one correct choice; sometimes they are all bad and you may just have to choose the one that is least offensive.

Every pharmacology lab unrolls in much the same way, covering most of the cases we are likely to see in practice and emphasizing those where the decision-making process is not easy.

Parasitology is fairly similar to pharmacology lab.

The beginning of the semester felt like we were studying an entomologist’s encyclopedia: “Here are a dozen ticks (or mites, or lice, or fleas, or nematodes); figure out the best way to tell them apart under a microscope.”

Fortunately, after deciding we had successfully jammed all of that information into our brains, we were able to move on to clinically relevant discussions. Different professors discussed the parasites we were likely to find on the most commonly treated species, emphasizing those that are very common or very detrimental to the animal or the producer’s wallet.

Most of the time, this meant working through a case: “A commercial dairy-goat producer has been having issues with her goats not keeping weight on, and a few have died. She deworms the whole herd with Ivermectin every two months and didn’t have any problems until the rains started a few weeks ago, etc.” Your job as the student is to correctly determine the parasite, treat the parasite, and then educate the client on the best method of prevention for her herd (hint—it’s not “deworm every two months with Ivermectin”).

Throughout this exercise, common parasites of the affected animal are available on slides or in specimen jars, and clinicians are there to answer any questions that may come up. We were also able to do several important clinical diagnostic tests, things vets do every day, like fecal flotation and heartworm tests.

Pathology lab is for those who like getting your hands dirty and staring at gross things; it’s the study of how disease affects tissue, so there’s nothing normal in pathology lab. You’ll see abscesses and cancer, pneumonia and partially healed wounds, nasal cavities that have lost all structure and mineralized vessels.

The best part about path lab is that all of the pathologists love making lesions “relatable” and easy to remember. So, it’s not a lymph node filled with caseous exudate; it’s a ball of your favorite cheese. It’s not chronic passive hypertension of the liver; it’s a “nutmeg liver.” This is made extra fun when they schedule pathology lab right after lunch.

You may get to put your hands on some necrotic intestines and pull fibrin off of a cow heart (wearing gloves, of course), but you will be learning while its happening. Pathology lab is designed as a hands-on, practical workthrough of the disease discussed in class, and we are expected to identify lesions that are placed in front of us.

That can be a lot to ask of a stressed out second-year, but it closely resembles what we will see in practice one day, so we persevere. I appreciate having these labs so that we can hear cases that are actually seen in the hospitals and work through them ourselves with samples and specimens beside us, even if we get it wrong; they’re bringing us one step closer to the dream of doing it all again one day as Doctors of Veterinary Medicine.

Conferring with Peers and Professionals

Mary W.We’re now a quarter of the way through the semester, with a few exams under our belts, and the Southwest Veterinary Symposium (SWVS) right around the corner. For those who thought that veterinary school was all about studying yourself into a hole in College Station, let me tell you it doesn’t have to be that way. Vet school presents a lot of opportunities to its students, and one of the most valuable, in my experience, is free registration for veterinary conferences. If you happen to have an interest in snakes and reptiles but feel like you won’t get enough information on how to treat them in vet school, head to ExoticsCon in Dallas and spend a few days surrounded by herpetology enthusiasts! If you hope to someday be a veterinary dermatologist and are ready to be immersed in the community, there is a conference for you, too. Whether you want to learn more about a particular topic, hear from a world-renowned speaker, or just get out of town for a few days while still feeling productive, veterinary conferences have something to offer everyone.

This past year I had the good fortune to be able to attend three conferences around the state and the nation. The first was SWVS in Fort Worth. This is a local conference, held in a different city in Texas every year, that provides a way for veterinarians to gain continuing education credits, stay up-to-date on regulations, and meet with old friends. As a student, SWVS was a nice way to feel like all this studying and struggling might eventually have meaning. It brought home the idea that I will be a veterinarian and I am in the right place to pursue that dream. Being surrounded by hundreds of vets who have all made it through the same courses I am currently in was inspiring, and exactly the kind of pick-me-up I needed after two grueling anatomy exams. In addition to that, I was able listen to a variety of lectures that helped support what I was learning in school.

The second conference I went to was a hoot. Parrot Festival is held annually in Houston and is billed as a place for parrot lovers to gather, shop, and learn a bit about new recommendations on caring for their birds. Texas A&M CVM’s own Dr. Sharman Hoppes spoke about common disease seen in Psittacine birds. Parrot Festival is not a vet-based conference, so it was actually on a level I understood, with lectures including words and concepts the average veterinary student could grasp. Additionally, the people attending the festival were there to have fun and to really celebrate these birds that they loved. It was a happy, loud, colorful way to spend a weekend.

Conference No. 3 was the biggest one out there. I attended the annual AVMA conference in Indianapolis this summer. I considered myself a bit of a “conference pro” at this point, but nothing prepared me for the sheer size of AVMA, which was attended by 7,000 veterinarians and related personnel. Seven. Thousand. 7,000 people who have chosen this profession for their own, have committed to a lifetime of learning, and are trying to be the best animal caretakers they can be. As a student, not only was this inspiring, but it was also a massive networking opportunity. Without seeking anyone out, I went home with multiple externship offers from clinics for my fourth year.

I would encourage anyone attending vet school or involved in the profession to try and go to at least one conference. Not only are they educational and can help you figure out what path you want to pursue, but they are also massive gatherings of the community you have chosen to be a part of. Plus, you get to leave vet school behind for a few days and remind yourself of why you wanted to go to vet school in the first place.