Career-Affirming Moments

On Tuesday, we had a lab about hematology. We made blood smears, did differential white cell counts, determined total protein, and generally had a good time pretending to be real doctors. (And by "real doctors" I mean people who have graduated from veterinary school.) 


There are five major classes of white blood cells that circulate in health individuals: neutrophils are the most numerous, followed by lymphocytes, monocytes, eosinophils, and basophils. Eosinophils are fairly rare, but you can usually find one if you're patient. Basophils, on the other hand, are much rarer, and the pathologist teaching our lab told us not to even bother looking for one because we probably won't find one. This line is not unfamiliar, and I have spent wasted enough time looking for basophils (by "enough time" I mean probably 10 minutes out of the entire 45 minutes of my life that I have probably spent looking at blood smears) that the thrill of the hunt is completely stale. Other people have seen them, I believe in their existence, and that's good enough for me. To thrive survive in the world of science takes a little faith, sometimes. 


And sometimes, science rewards that faith. Like on Tuesday, when I, Jane Herriot, was blessed with the presence, in high-power field number eleventy-something, of what was confirmed to be, really and truly, an equine basophil. I was driving the microscope and my friend C— was sitting across from me looking at the slide through the second set of eye pieces (double-headed scopes rock!) and tallying cells. We were about half way through the differential white cell count. We finished counting the field we were viewing and I moved methodically to the next one. My eyes were met with this: 

(from: http://sites.google.com/site/scienceprofonline/PBBasophil.jpg)

C— and I looked at each other, the look that says, Are you seeing what I'm seeing? We called the professor over, and she confirmed our find! It was a great day for science.

The real career-affirming moment came today, though. We were sitting in the computer lab working through guided coagulation case studies, when the person sitting across from me mentioned having seen a basophil in hematology lab. "I saw one, too," I said. Person-sitting-across-from-me's lab partner looked at me in awe and said, "Can I touch your hand?!?"

You know medicine is for you when your classmates think you're a hero for finding a basophil on a blood smear.

I heart physiology

I'm going to specialize in internal medicine. The most amazing thing is that I never knew how amazing and interesting physiology was until this year. Surgery is easy. Surgeons open their patients up, see what needs fixing, and fix it with sewing kits and Erector sets. Alright, which is pretty cool. But, internists!

Internists are detectives, ferreting out clues to the inner workings of their patients. Their hands pick up subtle differences in the size of lymph nodes. Their ears pick up faint sounds in the lungs. Some of them can even smell metabolic imbalances! In the midst of all the interconnectivity that is homeostasis, they find the soft spot, the organ that's not pulling its weight, the organ that's trying to steal the show. Then, they carefully select a drug from the pharmacy that will set things in order. Willy Wonka would have been an internist.

I mentioned interconnectivity, but that was an understatement. No cell in the body does anything on the sly. Right now, I can consider approximately 2 organ systems simultaneously, and it feels a lot like trying to recall one song while the radio in the background plays a different one. To illustrate, the negative feedback pathway for osmoregulation, below, is about the maximum level of complexity that exists in my understanding today.

 (From http://www.bbc.co.uk/scotland/learning/bitesize/higher/biology/control_regulation/negative_feedback_rev1.shtml)

In contrast, the image below is a scientific attempt to characterize all biochemical pathways in one cell.  

(From http://abeautifulwww.com/GeneVisualizations_E01C/roche1_3.jpg)
Close up of N3, showing some steps in the metabolism of glucose.

(From http://www.expasy.ch/cgi-bin/show_image?N3)

It's no different from learning your way around a new city. At first, you might only know the way between school and home, and then, you might know how to get to the grocery store, but only from home. Eventually, not only can you get everywhere you need to get, but you also know the fastest way from school to the grocery store, whether or not you can stop at the bank or the gas station on your way there, and whether you should stop at the post office before school, on your way to the grocery store, or on your way home at the end of the day.

Eventually, I'm going to have that map in my head!

Physiology is an incredible symphony, isn't it? Our job is to learn to hear each individual instrument and to pick out the melody from the harmonies.

It's not tax season, it's financial aid season

What's the difference? Financial aid season is just like tax season, except you have to fill out 3 times the number of forms, answer questions about this year's taxes, last year's taxes, NEXT year's taxes, AND your parents taxes, turn them in a month earlier, and instead of giving you a refund and sending you on your merry way, the government gives you a loan and tells you to keep in touch with Sallie Mae. My parents may not be able to claim me as a dependent anymore, but Sallie Mae sure as heck could....

In addition to the boring financial information, my Institute of Higher Education also collects a personal statement. Theoretically, I know what I want to do when I grow up, because I'm in vet school, right? Wrong. The beauty of vet school is that you don't actually have to decide what you want to be! I've taken to calling it the liberal arts of science and medicine. Amazingly, when I sat down to write my personal statement, the words flowed effortlessly, and I like what I ended up with enough to share it.

Before I started college, my response to the question "What are you going to be when you grow up?" was, unwaveringly, "An equine vet!" As I made my way through four years of undergraduate study, I realized my interests ranged far and wide. I majored in biology and minored in psychology and chemistry. I especially loved microbiology and immunology, but also truly enjoyed classes I took in political science, art, and American studies. For awhile I wanted to be a vet pathologist, then a behaviorist, then a vet in public health, and then a research scientist. After an internship on a dairy farm, I thought for sure I had found exactly what I wanted to be-a dairy vet! Eventually, I realized that going to vet school would afford me the opportunity to pursue any and all of these interests, and that I wouldn't have to pick just one of the ways of practicing veterinary medicine. That being said, I am still in love with dairy cows, and plan on working with them in some capacity. I could be a rural mixed animal practitioner, a general large animal practitioner, a food production vet, a public health vet, a vet who lobbies Congress on behalf of the dairy industry, a vet who discovers a new treatment for mastitis, or an equine vet who has a hobby dairy farm. More likely, that list wasn't a list of many different career paths, but a list of many stops along one career path. I am not sure what I will do immediately after graduation, but feel quite certain that my career will include research and teaching in addition to clinical practice. In the meantime, I've found plenty to keep me busy outside the lecture hall. I put in a few hours a week working in the pharmacy, and I also work in Dr. Got Milk's lab, feeding and milking the cows in his mastitis research studies. I joined the veterinary fraternity, and am currently serving in the position of alumni chair. I have also just gotten back into riding horses, and look forward to my weekly lesson with the same anticipation I did when I was 6. Maybe I'll be an equine vet after all...

Does time still have to follow those energy and matter rules?

You know, the ones about how neither energy nor matter can be created or destroyed?


It must, because I'm quite positive that in the last 5 weeks, entire days have been AWOL. Really, if 35 calendar days have passed, I would have gotten tons more work done! I'm onto them, though. They're right there in the middle of those lectures that claim to last only an hour by the clock, but that seem to drag on for a week!

Career-Affirming Moments

Every Wednesday morning at 7:30, the large animal medicine department presents a case or two. It happens that Wednesdays are the only day of the week I don't have to be at school by 8 am, but medicine rounds are my favorite, and I needed a better reason than my impending mid-term to get up and at 'em this morning, so there I was. The student on the rotation began presenting the case, a horse with chronic eye problems. This is where it gets good--just last night, we had a dinner lecture about large animal ophthomology cases, so I was hopeful I might have picked up a relevant tidbit or two. I'm going to skip the boring part where I knew the answers to some of the questions the student asked and get to the career-affirming part. (Which is not to say that knowing the answers to questions isn't career-affirming...)

Not only are dry eyes not very functional, but they can also be extremely uncomfortable, so it is imperative that that their normal hydration be restored. If a medical treatment is unavailable, the treatment of choice is a surgery called parotid duct transposition. The parotid gland is one of several salivary glands, and its duct takes a superficial course from the angle of the mandible (corner of the jaw) along the ventral border of the mandible (the lower edge) and then up, to open inside the mouth on the cheek next to the first upper pre-molar. The surgery moves the parotid duct opening from inside the mouth to the outer corner of the eye, replacing the normal tears with saliva. Parotid duct transpositions are actually performed quite frequently in dogs, but the large animal hospital here had only performed two of them on horses, and our case at rounds this morning was the third.

Now, here comes the career-affirming moment: while she was talking to us about possible post-surgical complications, the student fed the horse a carrots. Chomp, chomp, chomp, chomp...another carrot....chomp, chomp, chomp.... And then, a tear welled in the corner of the horse's eye and rolled down his face, followed by another, and another. Of course, the tears we saw were not tears at all, but saliva, showing that, at least initially, the surgery was successful!

As amazing as it was to witness that success as a knowledge-thirsty student, I can only imagine what it must feel like when you know it was your hands that performed that little switcheroo.

These are my people

As the summer wore away and I thought more and more about starting vet school, I was most looking forward to meeting people and making new friends.  This was in stark contrast to when I went off to undergrad: Back then, I was most worried about making friends and meeting people. I had known my best friend since kindergarten; I had known all my good friends at least since the 6th grade. I did not believe that four years of college would be enough time to make the same kind of relationships as those I had with my childhood friends. Naturally, I was completely wrong. It turns out that when you live with, eat with, learn with, practice with, and have fun with your peers, you get pretty close. Having realized this fundamental tenet of higher education, I was very excited to go back to school. I knew I was going to meet people I would be friends with for the rest of my life, but again, I was surprised. During orientation, we spent so much of the time sitting and listening to people talk, we hardly had any time to talk amongst ourselves. While we did have a team-building activity with our tutor groups, it was still a week before two of my groupmates and I all realized we hailed from the same state. The hardest part of my transition to life in vet school was that period when, while I was becoming acquainted with my classmates, I still didn't have any friends. We weren't sitting in lectures yet, we didn't have lab groups yet, and we were done at 5 in the afternoon. My mind was full of home, what my friends were doing, and the fact that I was in a new place with out any of them. When I was finally too busy with studying to worry about making friends, it happened. I didn't realize it all at once, but rather, noticed in little moments. Someone waved hello across the parking lot. Someone said good morning to me as I sat down in lecture. Someone offered to grab me a school paper to read during lunch. Someone invited me to pull up a chair in the cafeteria.  Someone wanted to be my partner during lab.   Someone smiled at me in the library. Someone wanted to study together over the weekend.

So, almost imperceptibly, I acquired friends, and they are just as wonderful as I knew they'd be. They are thoughtful, kind, interesting, worldly, well-read, funny, crafty, musical, athletic, good cooks, and so, so smart. I don't remember now exactly what the occasion was, but a few weeks ago, I was with my friends, and a thought made itself forcefully present in my mind: These are my people, this is my niche, here I am, where I belong. There is no more self-affirming thought that that.

The Gauntlet

That's what they should call Anatomy, or at least the anatomy final. In addition to the comprehensive dissection of a dog, the course includes lectures on anatomy, histology, and embryology, histology and radiology dry labs, and a series of self-directed wet labs that cover the comparative aspects of the 4 major body regions. I came back from the mid-term motivated and ready to settle in and study as much as humanly possible, but the only way to study enough is to forgo eating a nutritionally sound diet, exercising every day, maintaining a socially acceptable level of personal hygiene, completing household chores, and walking the dog. Having written that list, it is glaringly obvious to me that neglecting all those activities is clearly a recipe for insanity, but it is all to easy to believe that studying enough is possible. The key to success in anatomy is not to spend all your time studying, but to spend some time not studying. I spent a few weeks after the mid-term trying to study enough, until I realized I was seeing my dog for an hour in the morning, during which time I was focused on getting ready and out the door, and for an hour or two between getting home from school and going to bed, during which time I was getting ready for the next day and for bed. When I had that realization, I made an effort to spend a few hours at home in the afternoons. I'll admit, I still didn't always walk the dog, but at least I wasn't thinking about anatomy.

During the weeks between the mid-term and final, I also made some new friends/study buddies. P–– and E–– live in a neighborhood just a couple of miles from my house, and it was a combination of factors that brought us together: E–– and I were in lab together, my car was on the fritz, and P–– and E––, and the rest of their housemates watch The Office together. Thinking back on all of that now, it literally is a blur. Our schedules were hardly the same one day to the next, but the pattern of going to school, studying in the library, eating dinner, and studying some more was still enough that the days and weeks run together. Even once my car was fixed and I was spending more time at home, the routine was still such that I felt buoyed along, caught up in the torrent.

And then, seemingly overnight, the final was just a few weeks away. Those last 2 weeks are what I imagine the last 2 miles of a marathon to be like: every muscle (brain cell?) hurts, but the end is almost within sight, and that's enough to keep going. I couldn't have done it alone, either. My friends and I studied together, and that was important, but we kept each other sane, too. P––'s brother J–– even bought us pizza one night. P––, E–– and I planned out our studying, and looked at our cadavers every day. I didn't walk the dog. The heap of dirty clothes grew, as did the stacks of papers on my desk. I ate cafeteria food for lunch and Ramen noodles for dinner. On Friday, I spent 15 hours at school. And finally, on Sunday, after studying all day, E–– and I took the afternoon off and cooked butternut squash soup. It was sooo good! I'm reminded of a quote I'm fond of (Brian Andreas is the author):

There are things you do because they feel right & they may make no sense & they may make no money & it may be the real reason we are here: to love each other & to eat each other's cooking & say it was good.

Vet school often doesn't make sense, and it certainly makes no money, but boy does it feel right.