Colleague and criticism

Over one lunchtime, me and two of my clinical lab groupmates, E and Z, had an interesting albeit short conservation about criticism. As we know that we all will be working together, and seeing each other almost 24/7 next year. We will really get to know each other through and through, and it will be similar to having intensive orgies relationships with an expiry date as of Dec 2012. There are bound to be some degree of interpersonal conflicts, if we don't communicate properly. Our group consisted of six people, equal number of guys and girls, but only one straight guy, lol. L is my lab partner, and we often have cafe hunts together. She is also my philosophy conversee. Z is the poor straight guy, who frequently answers a lot of my questions regarding treatment. Before I digress any further, how can we provide criticisms due to good intentions, without upsetting someone?

Halitosis (bad breath)

Me: Let's start with bad breath. If you start talking to someone and notice the smell, how would you deal with it?
E: Hmm.. that's hard. But if I know that person well enough, I would tell that person outright though not out loud. Otherwise, I will hand out some chewy or mints.
Z: What if you don't have any of those with you? What if that person is a lecturer/teaching clinician, whom we will be spending a lot of time with?
Me: I guess for that case the prognosis is hopeless. Well... better start training holding your breath then?
E: Oh.... for your information, please let me know if I have a bad breath. I don't wanna be talking to clients while they try not to breath. Hey... GVP, you're quite lucky then. Don't you get use to all the bad smell, since you spend so much time in the PM room?
Me: You're right. So far I can even put my face near rotten horse guts, and it seems that I have instinctively learnt to shut off my nose, but I can still smell farts and bad breaths somehow. Another thing, this year I have morped into a little grumpy beeping bomb. I know that I swear too much, but I can't help for now.
Z: That's alright. We are quite stressed right now, so everyone swears and used to it. Remember the surgery lectures, how many times did we hear vagina, penis, testes?
E: There were so many vaginas, penises and testes. That was more than enough.
Me: One thing that we won't have enough of next year rotations will be sleep. I will definitely get moody, and swear a tad more than usually. So tell me to f!@# off and get some coffee, if I'm acting like a dick.
Z: Only if you promise, you won't treat me as your PM customer after I tell you so.

In the end, we also talked about dandruff, dress code, low jeans exposing ass crack, etc.  We all agree that we prefer honesty, and don't mind being told off if there is something odd. Feeling upset is inevitable at first, but as long as there is a good motive behind, everything will be alright. One point that we took, before rushing to our prac class was that all of us are not perfect, but at the very least we strive to improve. Being optimistic as I am, I often think that if someone criticise me, it's only because they care about me. What is your approach to this?

A long macchiato

When I started this blog, food was definitely on the topic list. So this shall be the first post about my eating habit!

Several of my vet friends and I have been locking myself up in the college libraly, trying hard to stay focused on studies. It is not uncommon to be hearing us swear and scream for no reason, as our sanity is certainly questionable. One thing, that stops me from crossing over to the other side completely, is unarguably having gourmand moments and getting decent coffees.

Smiley alien :)

Over the weekend, I had my usual cafe hunt/ritual, and found a nice little cafe, called Fix espresso. After having been caffeinating here and there over a few years, I seem to have developed invisible antennas, which somewhat detect decent-caffeine outlets. The smell, ambience, sound of milk foaming, and barista (wearing a classic grey vest) ticked the boxes. So I proceeded to settle down with study notes, and called for a long macchiato as well as their big breakfast. I couldn't help but smiling when my coffee was served. The latte art was just so adorable, in addition to strong coffee as I expected. The breakie was an average Joe, on the other hand, but the coffee won the merit.

My habit has me wondering what is going to happen when I move to another city with less renown coffee culture. I already have a little stovetop, which is used daily if not twice, but the experience is not the same. And before long I will start craving and showing withdrawal symptoms. One thing that I have promised to do over this Christmas holiday is stop having coffee for a month. It will be interesting to see how I deal with my addiction, in the near future.

Veterinary consult

As always life has been busy, but it got out of control recently in my case. The uni workload has increased as we approached to the end of the year. I seemed have hit my mental burnout, and felt quite depressed, but it appeared to be a common and "normal" thing among students in my year. After rejuvenating over one weekend with decent coffees and food, I felt much better once more. I really live on good food mentally and physiologically, ain't I? Hopefully, I will have more time for social life and this blog after my exams in late November.

Right, back to the topic. Veterinary consultation - hmm, I have little experiences with consults to be frank. The whole thing isn't very appealing for me personally, though some owners are quite sweet and lovely to chat to. Much like any other jobs dealing with people, servicepersons are bound have something to gossip about behind scene at the end of the day. In our case, it is behind the consult door and far away from the ears and eyes teaching staff/clinicians. Certainly, doing such deed is un-professional, and it is a breach of confidentiality, but we can't help being humans. Of course, no name or anything specific that may identify the clients is mentioned.

Anything in there?

How often you know that people aren't be honest outright. Well, that occurs frequently in veterinary consults. Owners sometimes tell us what they think we want to hear, but not the truth. Figuring out what is wrong with our little furry mates is much like doing jigsaw puzzles and detective work - integrating relevant information to make some sense or list differential diagnoses ie. likely causes/underlying pathology. When the truth is not given, our life is much harder and it's our friend who suffers consequently - well, our friend will then have an increaesd chance of becoming my customer on a PM table as a wrong diagnose can be proven fatal.

We were told of a case of a Labrador, responsible by the ER/critical care head vet. The dog was presented with pollakiuria (increased frequency of urination), hypersensitive sound (very hysterical even to being called its name) and hallucinated (it seemed to be chasing invisible flies in the consult). As usual, interesting and exciting things happen on Friday night. There was a little wine party at the owner's, and the dog became like so after the party.  She sedated the dog, did a thorough physical exmaination, checked the mouth and found bits of chocolate brownies. First thing cholcolate is toxic to animals, but they don't show neurological signs like these (chocolate toxicity will be posted at a later time).  Second thing is the brownies were no mere baked goods in this case. With her experience, common thing occurs commonly. She had seen way too many marijuana toxicities, and she believed that the dog munched on hash/weed brownies. She asked the owner explicitly to confirm if there is anything special in the brownies, and the owner did not say anything about the recreation drug. She then proceeded to explain the clinical picture and most appropriate treatments. The dog was induced to vomit, and she found some grass like materials with partially digested brownies. Thinking about probability the dog could have been poisoned from other source, but given the clincial signs and history of party, ingestion of brownies, it is most likely that special brownies were made for the gathering, and the dog (being a Labrador) managed to get some bites. I would say that vets with less experience and knowledge in critical care and toxicology, would not have figured that out right, and the patient's health could have been compromised as appropriate treatment was not provided promptly.

Like I said before, veterinarians are not in the consult to judge. We just want to do our jobs quickly and finish the session within the time limit (usually, 15 minutes). But, some owners just love talking on and on about their life, sometimes including private detail that we don't want to know. Consult charge is per 15 minutes, and some do not realise that they pay for us to listen to them talking. I guess it's better if they see a psychologist for this purpose.

An ideal consult would be a client come in with a calm and relaxed patient, facts provided, quick exmination, diagnostic process/work-up/tests, confirm the diagnosis, advise about the disease, management and treatment options. Fitting all of these in 15 minutes is challenging. Even though this is what majority of the profession are doing, sometimes it is not ideal since proper discussion of the disease and management are often left out. Many vets just reach for treatments eg. corticosteriods, antibiotics or NSAID, and tell owners to give the drug(s) to their pet without telling why. Consults are pretty much the balance between medicine and business. With the skills and experience I have right now, I would take ages to do a proper consult. Practice makes perfection, I guess.

Horse racing industry and horse vets

I have to admit I have never had a good impression of the Victoria racing horse industry. The industry is no doubt lucrative, and there is a lot of money talk involved as well as liability issues.

In the past weeks, a racehorse unexpectedly died on the racing track. There was a lot of public concern in term of animal welfare and jockey's safety. The field pre-emptive diagnosis for the cause of death was heart attack, which left me puzzled because I had never heard horse vets mentioning the condition before. So it left me to think that the racing industry must be trying to avoid negative public response, since there has been a fair number of accidents on race tracks. Animal welfare and right groups have been grilling and putting the racing industry on a hot seat.


Having confirmed the cause of death with the pathologist who performed the necropsy, the diagnosis was severe acute pulmonary (lung) haemorrhage, which was EIPH (exercise induced pulmonary haemorrhage). This condition is well known in racing horses doing strenous exercises though the severity of the condition is variable. The degree of bleeding the horse suffered was so severe that its chest was filled with blood. Oh poor horse! If this was to be known, there is no doubt the industry would suffer.


Anyway, there was case in pathology weekly round, which was likely to involve a lawsuit. We were looking down a histology slide of a horse's vein and told that the horse received IV (intravenous ie. into a vein) jugular (neck) injection of phenylbutazone, commonly used NSAID (non-steroidal anti-inflammatory drug eg. paracetamol) amoung horse vets. And apparently the horse got sick then progressively deteriorated over a period of 6 weeks before it died despite appropriate treatments. At the request of the owner, a necropsy was performed and samples of several tissues were collected for histology. Histopathology - evidence of endothelial (cell lining the vessel) damage, necrosis (cell death),  adhered thrombi (blood clots) and recanalisation of the vessel. There was septic thromboembolism (spreading of blood clots) due right vegetative (growing) endocarditis (inflammation of the heart valve) and embolic suppurative pneumonia (pus-sy inflammation of the lungs). In a nutshell, the injection led to sick neck vein, heart valve and lungs. It appeared that the vet mistakenly and injected the drug into the mural (wall) component of the vessel.

Why do we bother describe all those tissue changes (what I put up above is summarised version, by the way). During the round, there was an empathic row of laughters among us when the finanical value of the horse was known. The horse was worth AUD$3millions, for god's sake! And the legitation is now therefore worth the same amount, for the defendant's sake ie. veterinarian's! I do hope that the vet has some sort of work insurance otherwise he/she is screwed.

What a pity! They don't continue to make the calendar.

In general, horse vets are somewhat intimidating. They are quite uptight and strict but perhaps this is due to the nature of industry they work in. Of course, this is with a few exceptions. There is a male resident horse vet who was the topic of conservation among the girls (about of 80% the course are female, by the way) for a while when we first had a prac class with him - smiley, green eyes, hunk (albeit he is shorter than me) and sarcastic sense of humour.  In many movies, people working with horses and the work environment are depicted as macho and masculine. This often leaves a train of lecherous thought in one's mind; how much one fancy about doing XXX and enjoy having YYY in a horse barn!

Desensitised to the dead

A while back, I used to watch all those medical shows and wondered how doctors perform surgeries without feeling disgust. And now I understand since I has become desensitised, and I am able to perform necropsies while talking about lunch. It feeks like yesterday when a group of us vet students got excited for our first anatomy prac with dog bodies. But, we were warned that if we feel funny, just exit the prac room and get some fresh air. A fair amount of students, including me, felt light-headed and almost faint. It was the smell, sight and texture of cold muscles that almost made me puke. Well, I turned into a vegan and didn't touch any meat for a week. Then we had more anatomy classes, seeing images in lectures and touching the real stuff in pracs every fortnight. We gradually accustomised to the extent that we felt hungry during the prac, and talked about having steaks and beers after cutting a dog open. This is so wrong I know.

That only leaves one thing that a lof of people complain about while dealing with the deads - Smell! Well, some ex-patients are not so fresh and presented to us at a temperature lower than ideal ie. from a fridge. I think I'm somewhat more lucky than my peers that I have learnt to shut off my sense of smell while perfoming necropsies. One of the pathologists I know mentions about pathologists just get used to the smell, and our nose just doesn't smell anything malodouraous after a necropsy. Once she and her colleague had to do a necropsy of a baby hippo who disappeared for a few day during a period of warm Melbourne weather, and then appeared to float atop of the enclosure pond. The body was so emphysematous (bubbly like balloons) and the odour was ranked 10/10 in the degree of intolerability. After several hours their job was done, they returned back to the faculty, sitting in a staff tea room completely oblivious that they both had this obnoxious un-holy aura, which could be sensed several blocks away. The whole faculty became alert of the smell, and believed there was a gas leak hence commenced buidling evacuation unbeknownst to the offenders still in the tea room enjoying the sun and English afternoon tea.

Obviously, I have to be more careful from now, and take cautions about the scent. It would be horrid to others around me if I pop into a cafe for coffees after my heavy duties.

Human vs veterinary pathology

The topics of conversations, that my medico friend, P and I talk about, can be quite taboo in the ears of general public. The topic may involve saying vagina and penis out load, as we talk about reproductive medicine. Other includes how to open the skull, amputate a limb etc, and cases that we have. During one of our Sunday cuppa ritual, we ended up talking about two distraught cases she just had.


NOTE: This synopsis may be very distressing since it mentions an abused baby and body parts after an automobile accident.

GVP: Guess what, I got accepted as an extern in veterinary pathology to a few uni in US and UK !
P: Awesome, I know you love path, and for sure you're gonna enjoy it. The subject is quite interesting, but sometimes the pracs and work can be very depressing for us, as a lot of human pathology cases is related to forensic.
GVP: Hmm, like what?
P: Err, human pathologists deals with too many murders and accidents. I tell you about a case that we had the other day in our tute. There was a baby came through with oedema and congestion (basically, the head looks swollen and purple-red) from the neck upwards, and there were two faint lines around the neck. We were asked what is the cause of death, and no one got it right despite being told that it was very obvious. The tutor told us that the an electric cord fits rather too well with the lines on the neck, and make the exact impression if you try wrapping one around your neck, in which she/he demonstrated so. At this point, there was an ominious cloud floating in the room, and you could tell what everyone was like what the F!@#$~~~~~~!

P: Then, a  few people started hyperventilating (breathing fast) and you could tell people were having tears in their eyes, and my eyes were watery.

Then she told me about a gruesome case of a car accident. In essence, the body came in several pieces, and the forensic officers had difficulties collecting all the parts at the scene: brain materials, eyes, visceral organs here and there. I had an impression that the body trunk got crushed like a garlic in a press. The impact was so sever that the garlic was sent flying and splattered - also not to mention obvious mutilple opened bone fractures (fractures with bones poking out of the skin for us to see)
Lesson learnt, especially to male audiences out there: stick to the speed limit, drive slower won't kill yah!

At the end, we both usually thought that we're not desentisied about this sort of things in general, but that whole thing was just sickening. There is too many funny people on this world.

After exam resolutions

Shhhh... a customer coming.

I have been working my ass off this year, and my brain may has become macerated with all the studies cram in. Since February we have been doing your-ass-rooted-to-the-seat 9AM-5PM lecture-day 3 three times a week, and cram-it-in-your-head 10AM-5PM practical day about 2 times a week. What a hideous routine, only to halt momentarily due to a month winter break between semesters. Oh, dear I'm mentally exhausted, but the light at the end of a long abysmally dark tunnel is shining through. There are several things that I look forwards and resolute to do when this nightmarish journey is over.

- Go camping for 5 days and complete the latter half of 104km Great Ocean Hike with other vet kids
- Go surfing and enjoy the sun for a week
- Try a hand cooking quails, perfect crispy skin pork, lobsters and making macarons - black seasame and passionfruit
- Leisurely read Pathologic Basis of Veterinary Disease, The Beginner's Guide to Winning the Nobel Prize: Advice for Young Scientists by Prof Doherty whom I have seen in real life, and those long overdue books which are supposed to be read by all veterinarians, written by James Herriot
- Watch movies and go to art galleries
- Bike around the city and hunt down decent caffeine outlets
- Pamper at Daylesford
- Last but not least, enjoy mind wondering, have epistemological moments, and do more blogging

Without having anything to look forward to, I would have gone nutbag and adopted Dexter's hobbies as ways of coping. I can't wait any longer for this summer break, rejuvenate and get ready for a lecture-free clinical year starting early January next year.