The Jigsaw Puzzle

Nantika's picture from her white coat ceremonyNine years ago, I informed my boss that I was leaving the company where I had been working for 12 years to pursue a career in veterinary medicine. The only thing I had at that point was a serious commitment to start this journey.

But now my long journey to become a veterinarian has come to the last 15 months of veterinary school. In three months, I will start my clinical rotations, during which fourth-year veterinary students spend a whole year working in the Veterinary Medical Teaching Hospital as a real “baby” doctor.

I feel both panicked and excited to realize that my dream of becoming a veterinarian is about to come true.

I still remember the end of my first day as a veterinary student. I went home and cried. Why? I thought “Physiology” and “Anatomy” were so hard. I had thousands of pieces of jigsaw puzzles in my head. I asked myself, “How am I going to pass these classes?”

Now, I am a third-year veterinary student. And I have the answer for that question.

For the first two years, I learned the different aspects of veterinary medicine: physiology, anatomy, immunology, histology, neuroanatomy, infectious diseases, parasitology, microbiology, pathology, surgery, anesthesia, public health, pharmacology, toxicology, radiology, and many more. Each class is the part of the jigsaw board and has its own space to fill up.

The curriculum is designed to lay the foundation of medical knowledge, and by my third year, all of those jigsaw pieces start coming together and I could see the picture clearer.

I love small animal medicine, through which I can apply the foundational knowledge by analyzing, diagnosing, planning for testing, and offering treatments. Even though I choose to focus on companion animals, I also have learned about large animal medicine.

Additionally, I have selected electives to study particular topics of interest to me in small animals, equine, food animal, swine, avian, and exotics medicine. Some of my highlights were “Oncology,” “Cardiology,” “Clinical Pathology,” “Emergency Medicine,” and “Dermatology.”

Before the end of my third year, I will also have “Avian Medicine,” “Dentistry,” “Feline Medicine” and “Gastroenterology” classes. These are all bits of knowledge I will retain for my career.

It has been a long wait, but the fourth year is just around the corner. My last section of the jigsaw puzzle is about to be complete.

This beautiful picture from my White Coat Ceremony (held at the end of your second year) keeps me encouraged until I walk across the stage to become “Dr. Du, DVM.

The Drive

Nantika (far left) and her surgical team
Nantika (far left) and her surgical team

As I am driving along State Highway 21 from College Station back to Dallas for winter break, I am feeling both joy and anxiety.

 

My friend’s words are stuck in my head: “We are 5/8 doctor!” as we just finished our fifth semester in veterinary school. The joyful part is that I’m more than half way through my veterinary education; the anxiety-laden part is that there are only three semesters left before I become a doctor and go out into the real world.

It feels like it was just yesterday when I drove along this highway from Dallas to College Station for my vet school interview. Five semesters have gone by very fast.

However, it has laid a very strong foundation. The highlight of this semester was the surgery class. It was stressful, but I gained more confidence after each surgery laboratory, which includes a surgery group of three students rotating weekly through the roles of surgeon, assistant surgeon, and anesthetist.

The surgeon needs to be certain in surgical procedures and the anatomy of the patient. Once the procedure starts and the patient is under anesthesia, we are on the clock.

The anesthetist must monitor how deep the patient is under the anesthetic gas and that adequate oxygen flow is delivered to the patient. The blood pressure, heart rate, respiratory rate, and body temperature must be within normal range. The assistant surgeon needs to be sure that the proper surgical equipment and aseptically (protected against infections) technique be prepared for surgery.

During this learning process, besides the surgical knowledge, I also learned to communicate effectively with my surgerical team. Upon completing this course, I feel I’ve gained the confidence to continue my journey as a doctor.

I can see that next time I drive back home on this state highway, I will be driving as a “6/8 doctor,” and, finally, in May 2020, I will become “a doctor.”

Class Schedule, Exams, and Stress

Recently, on a veterinary school tour, I heard this question: “How does the class schedule look like?”

Dr. NantikaI rarely get asked this—I’m more commonly asked how hard it is to get into veterinary school—but this is an important question, because, in my opinion, I think that it is harder to complete a DVM degree than it is to get accepted to veterinary school.

To start, we can look at my spring veterinary class schedule and how I am dealing with this hectic routine. I start the week with Monday, 8 a.m. exams and end with my Friday, 3 p.m. class.

My daily studying hours are blocked from 7 p.m. to 1 a.m., or perhaps more like 3 a.m. Not being a morning person, this is a real challenge. It is important to know your learning style and quickly implement a study routine. This will save time for studying and will increase time for sleep. If you want to attend vet school, you need to get ready to put in that many study hours.

The exam schedule usually begins on the third week of the semester. The second-year vet students have exams almost every Monday and Friday. This continues until final exams at the end of the semester. Additionally, even though Tuesday and Wednesday classes start at 10 a.m., I still wake up and review the materials at 6 a.m. before the weekly quizzes (this semester, for pharmacology or toxicology). It feels like a constant pounding of studying, preparing, and taking exams.

The consequence of these class and exam schedules is stress. We all are dealing with it (differently, in some ways, and similarly, in others).

Because of this, I have found that it’s important to focus on my top reasons in order for me to keep going. These include:

Friends—It is delightful to have friends who accept your weaknesses and strengths. I have a language difficulty because English is not my first language, so my friends take time to spell things out for me or to explain things to me when I don’t understand the lecture. Many of my classmates were very competitive when we first got into vet school. But that competitiveness has gradually regressed as we all started to understand that we are here to be successful together. Every morning, one of my friends asks me, “Nantika, how it is going?” It’s a simple question that brings a smile and helps me get ready for the day.

Nantika Art 2CVM Counselor—I used to be afraid to let people know that I’m struggling through my classes. I stayed stressed and grumpy for my whole first-year fall semester. I became an unhappy and frustrated person, which impacted my productivity. I decided to seek help from CVM counselor Elizabeth Eaton. She guided me through accepting my weaknesses and fear of failure. I feel lucky that the Texas A&M Vet School takes the students’ mental health and wellness seriously. We also have a stress reduction room and relaxation space, where we have a massage chair and biofeedback equipment to help de-stress and help the body to achieve a relaxation response.

Time outside school—It’s hard to pull myself away from studying, but I realize I need to do something besides study. So, I chose to paint. While I’m painting, I really focus on the canvas and color in my brush. That is one form of meditation that I have started to enjoy in order to refresh my mind.

The love of medicine and animals—At the end of the day, I see the innocent eyes of my dogs, one of which recently got diagnosed with immune-mediated hemolytic anemia. It reminds me why I’m pursuing this career, because I want to learn medicine and use my knowledge to improve the health of the animals.

Life with a Little Lionhead

Nantika and Joujou
Nantika and Joujou Nibble, her Lionhead rabbit

Yes! It’s a typical thing veterinary students do,” I whisper to myself.

This is a story of the Lionhead and me. It starts one Saturday morning when I am attending the Rat and Rabbit Wet lab, hosted by the Dental Club. The objective of this wet lab is for veterinary students to get hands-on experience with dental care for rats and rabbits. The rabbit breeder brought various breeds of rabbits, big and small, so students can learn to evaluate rabbit teeth. All rabbits are cute, but my eyes stopped at one small rabbit, one with a wool mane encircling the head, which makes it look like a little lion! I had never seen this breed before. Then, the breeder announced that she is currently trying to find a new home for one of her rabbits, and she pointed to that little Lionhead. And…that is the beginning of my life with little Lionhead.

Lionhead is the name of the rabbit breed. The Lionhead rabbit is unique because of its mane, which looks like the mane of a lion. This breed is popular in Europe and is a relatively new breed in the United States. The first Lionhead rabbit was imported to the United States in 2002. The American Rabbit Breeders Association approved the Lionhead Rabbit as an officially recognized breed in 2014.

Before the Lionhead, I had never had a rabbit as a pet. Luckily, as a veterinary student, I have had my fellow vet students and my professors to help guide me through rabbit husbandry, which has made becoming a “first-time rabbit mom” an easy transition. I named him “Joujou Nibble” due to the malocclusion (the misalignment or incorrect relation between the teeth of the two dental arches when they approach each other as the jaws close) of his upper incisor teeth.

Here are some of the first things I learned as a rabbit mom:

Nantika's Lionhead rabbitLesson No. 1 for a rabbit owner is to learn to check the rabbit teeth regularly, because rabbit teeth never stop growing. Therefore, it is easier to get malocclusion, especially when a rabbit does not get the appropriate diet (hay, pellet food, or vegetables). Joujou Nibble goes to the Zoo and Exotic service at the Texas A&M Small Animal Teaching Hospital to get his teeth trimmed. When I first got him, the Zoo and Exotic service kept Joujou Nibble for a couple days while I got his hutch, timothy hay, oat hay, pellets food, bedding, hay rack, toys, litter box, and rabbit igloo (because rabbits like to hide). It was fun to get my house ready for the rabbit.

Lesson No. 2—if the rabbits do not poop or eat or drink in 24 hours, it needs medical attention immediately. Because Joujou Nibble was stressed from changing his home and getting his teeth trimmed, he did not eat or drink or poop and I had to take him back to see the veterinarian at the Zoo and Exotic service again. At the teaching hospital, the veterinarian and vet tech taught me to evaluate the degree of dehydration and give IV fluid, to listen to his gut sound, and to critical care feed a rabbit with a syringe.

Nantika's rabbit in his hutch
Joujou Nibble, in his hutch

Lesson No. 3—rabbits sleep mostly during the day and sleep with their eyes open. At night, Joujou is awake. I can hear him chewing his pellet food or running up and down in his hutch.

Lesson No. 4—litter box training a rabbit is challenging. The veterinarian recommends filling his litter box with rabbit litter and topping it with hay, since rabbits like to eliminate in one corner of the box and munch the clean hay. I have not been very successful in getting him use his litter box, but at least now I know which corner is his favorite inside the pen.

Lesson No. 5—do not yell or punish the rabbit for having “accidents” outside of the litter box. I gently patted him when he did not use his litter box, and that is a mistake! I learned my lesson; Joujou Nibble disapproves that, stomping his back legs when I got closer to him. This can mean “look out,” “pay attention to me,” or “I’m really angry.” I now know his stomp means “I’m angry at you.”

As time has gone on, I’ve begun holding him and talking to him everyday. He is finally willing to come to me and sniff my hand, which is a “yay” moment to me. It feels like when a baby says “mama” for the first time. Bonding with my rabbit is rewarding. As a rabbit’s mom and a future veterinarian, raising my rabbit gives me an understanding of the rabbit behaviors, signs of illness, and how to do physical examinations.

Joujou Nibble and I still have many more lessons to learn about each other, but I am enjoying every moment of learning new things about him; that is how my life with the Lionhead goes.

Keeping Swimming via Wet Labs

Nantika D.Time flies quickly—I feel that this is so true. One-third of the fall semester has already passed. When my day starts, usually at 6 a.m., it does not stop until midnight or as late as 2 a.m. As Dory, from the movie “Finding Nemo,” says, “Just keep swimming, swimming, swimming”…that’s each day for me. It seems tiring, but certainly not boring, because along the way I am learning many different aspects of medicine for different species.

As a second-year veterinary student at Texas A&M, there is still a lot to learn until I become a veterinarian. With little clinical experiences prior to applying to the program, I felt like a deer in front of the headlights. But soon enough, I learned that opportunities are always around, not only in the clinical skill labs provided in school curriculum, but I can also easily get clinical experiences outside of the classroom. The more I practice my clinical skills, the more confident I will be when I graduate.

One of the ways I receive hands-on experience during the semester is through wet labs. A wet lab is set up by the student organizations, of which there are more than 20 at the CVM, including student chapters of the national associations for Equine Practitioners, Bovine Practitioners, and Internal Medicine, and Emergency and Critical Care; groups focusing on Laboratory Animal Medicine and Zoo, Exotics, Wildlife Medicine; and many others. These wet labs are scheduled for the weekend or after-school hours, and each is supervised and taught by board-certified veterinarians who are specialized in the field being covered in the wet lab. Last weekend, I participated in a dermatology wet lab. Dr. Alison Diesel, who is board certified in veterinary dermatology, came to teach us to perform sample collection and diagnostic evaluations for ear cytology, skin scrapes, and impression smear cytology in dogs and cats.

Last year, I participated in five web labs. First, during an internal medicine wet lab, I learned to perform centeses (thoracocentesis, abdominocentesis, and arthrocentesis), esophageal tube placement, lymph nodes aspiration, and organ and skin biopsy (aspiration and punch biopsy). Second, during a lab animal wet lab, I learned to handle and restrain the rats, as well as to administer drugs and medications. Third, during a Surgery Club wet lab, I learned how to scrub, gown, glove, wrap packs, and suturing techniques and patterns. Fourth, in a cytology clinical pathology wet lab, hosted by the Pathology Club, I learned to look for abnormal cells under microscopes, which prepared me for when I take a pathology class this year. My last wet lab last year was the small and large animal dentistry, hosted by the Dental Club, in which I learned to determine the age of dogs and horses and how to perform canine teeth cleanings.

I recently signed up for an emergency and critical care wet lab. In it, I will get a chance to practice techniques such as temporary tracheostomys and watch the clinician demonstrate open-chest CPR. This year the Internal Medicine group also will offer an equine echocardiogram wet lab.

Participating in these wet labs allows me to explore more about veterinary medicine; it is a part of my veterinary school journey I really enjoy, a part that helps me to “keep swimming.”

Anatomy as a Third Language

On the first Gross Anatomy laboratory day amongst my classmates, I felt like I was Harry Potter on his first day at Hogwarts. Harry Potter wore a black coat, while I was in white. He carried the magic wand, and I had my dissection kit. Mr. Potter went to “Gryffindor” and I went to “Table 16.”

I find that learning the name of each structure in the body is frustrating but can also be fun. I didn’t grow up using English as my primary and first language. I have been living in the United State for nine years. Learning English as a second language is hard but I will always love learning languages. So, now I am learning my third language – Anatomy.

I really like how the Gross Anatomy structure is set up at Texas A&M Veterinary School. The professor sets the weekly objectives, which we use as guidelines to accomplish each week. The first objective of each week is to study Greek and Latin root words and their combining forms. Knowing what those root words mean makes anatomy easier. Initially, I just memorized where infraspinatus and supraspinatus muscles are. This is hard when you have hundreds of anatomy terms to memorize. (Memorization is not an effective way to learn anatomy anyway). After I learned what “infra” and “supra” mean, I immediately knew where those are on an animal scapula (shoulder blade). Infraspinatus muscle locates beneath the spine of a scapula, and supraspinatus muscle locates above the spine of the scapula. The same is true about identifying the nerve. I learn “phren” means the diaphragm, and immediately I could identify the phrenic nerve because it innervates the diaphragm.

I still have a long way to go in veterinary school, but finding different fun ways make me enjoy studying and relieve the stress. Thinking that learning anatomy as a third language is one of those ways.

Getting Ready for the First Exam in Veterinary School

I will be a veterinarian in 45 months. As much as I am excited about this statement, I am also anxious to know where my 45-month journey lead me. I have just finished my third week of my veterinary school life. I am proud to say that I am surviving and still going for my dream career. The first year class schedule at the Texas A&M College of Veterinary Medicine starts at 8 a.m. and finishes almost at 5 p.m.

The first semester classes include: Gross Anatomy I, Physiology I, Microscopic Anatomy I (Histology), Immunology, Veterinary Behavioral Medicine, and Clinical Correlates. It was no surprise that the first exam in veterinary school is Gross Anatomy I, and it takes place in the third week. So, three weeks into my 45-month journey does not give me much time to adapt myself to the professional student life and to cope with the fear of the anatomy exam. Here, I would like to share my experience getting ready for the first exam (and many more):

Don’t procrastinate: One of our professors warned us at the orientation that we would receive so much information at once, as if we are drinking from a firehose. This is a fact. Procrastinating, even for a few days, is not a good idea. Not being able to catch up to the class material can create a big stress. When you go home every day, try to study what you have learned that day. Please remember, “Procrastinate can become the stress.”

Find your study group: I didn’t realize how much I knew and do not know until I joined a study group. We quiz each other over the material. Sometimes, we take turns explaining the concepts to each other. Besides studying, we also give each other emotional support because we are in the same boat; we are going through the same suffering and joy. I feel so much relief to know that I am not alone.

Make it a long-term memory: Memorization may work, but I would not recommend it as a way to learn in veterinary school. This is true for anatomy class. Instead of trying to memorize the muscle’s name, attachment and action, try to draw a relationship of the muscle group and visualize where those muscles are. This will become long-term memory that you can recall whenever you need to.

Find your learning style: For example, when I study the physiology and immunology, I like to rewrite the concept of those subjects in my own words.

Find a sleep schedule that’s comfortable for you: Veterinary school’s schedule is hectic, and you will be exhausted by the end of the day. I have to keep studying productively, so I can have a chance to sleep longer hours. During the weekdays, with the amount of studying to be done, it’s hard to get more than eight hours of sleep. So for me sleeping seven hours per night is good enough.

DO give yourself a reward: It is not easy to balance your veterinary school life and personal life. I usually give myself the Friday night off. I give myself a nice meal or watch the movie with my friends or family. Even on a random Wednesday morning, I buy myself my favorite coffee. This simple reward keeps me going and waiting for the next reward.

I have learned so much in the past three weeks, and I think that I “BTHO the anatomy exam” as Aggies will say. At Texas A&M Veterinary School, I am surrounded by strong, supportive people, from the faculty, upper classmen, and my classmates. At the end of every day, even though I am very tired and don’t want to study, I don’t give up. This is what I want to do and this is where I choose to be.