The social hierarchy of my new living arrangement was established as quickly as introductions were made. Dave, who had secured the apartment, was the only U.S. citizen and was a good ten years older than Chris and me. He requisitioned the largest and best-appointed room with a bay window that looked out over a street of parked cars, occasional drug deals, and trash. Not exactly great, but compared to my tiny room with a view of the neighbor’s brick wall, which I could reach out and touch, it seemed luxurious.
Dave owned Max, the German shepherd, and three cats—who remained sequestered in Dave’s room. Max was middle-aged and had a graying muzzle that matched Dave’s receding hairline and increasingly accentuated widow’s peak. Their deep, tangible bond was obvious, and reflected in Max’s intense stare whenever Dave was in the room. Max spent his days either tightly curled under Dave’s desk in the hospital’s closet-like intern office or lounging in Dave’s bedroom. Max was a one-man dog, and Dave was a man’s man. Max would give me a cursory acknowledgment when I can home, a half-raised eyebrow if I addressed him directly, and a stubborn reluctance if I suggested a walk when Dave was stuck at the hospital. I suspected that his ambivalence toward me was a reflection of his owner’s feelings. It wasn’t that Dave wasn’t friendly, but I, once again, didn’t fit in. Chris and Dave were gracious enough housemates, including me on trips to Ikea to furnish our apartment and to the grocery store to stock my designated cupboard with peculiar foods that looked familiar but proved unsavory. But the beer-drinking, hockey-watching camaraderie immediately established between Dave and Chris was a club, and I wasn’t a member.
Chris was Canadian, and had rescued his young Doberman, Tye, from his vet school on Prince Edward Island. Chris’s red hair and beard (which he’d grow to a wild length during our internship) seemed to complement Tye’s liver-and-tan coat, and they shared an untamed energy. Tye was barely contained by the crate where he spent twelve or more hours a day while Chris was at the hospital, equally desperate to get out of his white coat. They, too, were a long way from home. Chris showed me pictures of his vet school lodgings—a solitary, dark wooden house, surrounded by the sprawling greenness of woods and fields with no buildings or roads in sight. It seemed a more appropriate setting for Chris and his rambunctious young dog than West Philadelphia, where the local park was best known for drugs and prostitution.
I was assigned the smallest bedroom, an afterthought of a room so tiny that it would’ve been impossible to swing a cat once my bed was moved in. The unofficial residents of the house included mice, rats, squirrels, and various decades-old mold spores. At first I didn’t believe Dave when he told me the fingertip-size dent in the neighbor’s door was from a bullet, but after my first week in West Philadelphia, I did.
At the start of my internship, I’d sit on my new Ikea bed in my new apartment, surrounded by an unfamiliar city, and wonder what I was doing. Every morning, I’d grab the portable phone from the kitchen, the black plastic slick against my palm, take it to my bedroom, and attempt to call home. The long numeric sequence of country code, area code, and then my home number was difficult to dial. The familiar double ring when the line connected was soothing—until it gave way to the hollow persistence of an unanswered phone. Even if I could get the sequence right, the time difference meant that everyone was at work when I called.
I’d hang up and search my address book for the number of one of my vet school friends, but my certainty that their new practices kept them busy and happy stayed my hand. I pictured them seeing patients, driving to large-animal calls, or chatting with colleagues about cases over a midmorning cup of tea. The familiarity I imagined them feeling, in spite of the novelty of a new practice, widened the distance between us, expanding the Atlantic Ocean from my phone to theirs.
In the first month of my internship I was assigned to emergency days, a grueling schedule of 7 A.M. to 7 P.M., otherwise known as “baptism by fire.” The fifteen- to sixteen-hour days I spent in the hospital left little time to worry about the social limitations of my living situation. Everything was suddenly different. The drug names I’d crammed into my head during vet school were now meaningless; I had to learn an alien language of U.S. names for drugs, along with entirely new units and reference ranges that clouded my understanding of normal and abnormal—the metric system replaced by strangely archaic ounces, pounds, inches, and feet.
The majority of the drug inventory available at the Veterinary Hospital of the University of Pennsylvania was formulated for human, rather than animal, consumption, a fact I hadn’t realized until I was the one writing the prescriptions. And, as such, concentrations of liquid medications, tablet sizes, and the amount of injectable drug contained in a vial were often inconvenient.
In school, I’d assumed that the medications discussed in lectures and used in clinics were made for the animals we treated. In practice, veterinary equivalents of the medications we used were unavailable. From insulin to antibiotics to narcotics, everything was labeled “For Human Use Only.”
The emergency room was the largest space dedicated to the care of small animals I’d seen, at least six times bigger than George’s consulting room back in England. There were three waist-high stainless steel tables for the triage, stabilization, and treatment of cats and dogs in the center of the room. One had a deep bath-like sink with a grate on top for “dirty” procedures such as clipping and cleaning wounds. Two large oxygen cages were stacked against one wall for animals with difficulty breathing—usually cats with asthma or dogs in heart failure, but once an albino boa constrictor with pneumonia. A small bank of cages off the central area housed patients who needed to stay for observation or further treatment. Big dogs too sick to be mobile—often those hit by a car—lay on blankets on the floor, where they could be easily monitored. The wall opposite the oxygen cages was lined with a bank of cheery blue-green cabinets and a work surface for processing lab samples, laying out supplies, and writing up treatment sheets. The long bench was crowded with baskets of different-sized intravenous catheters, syringes, needles, blood tubes, and the other equipment needed to stabilize a crashing patient. I’d never seen so much veterinary stuff shuffled into such a tight space—not even in the boot of Peter’s SUV.
There were no windows, and the only way to determine the passage of time was the clock above the doctors’ station, which was a small nook for writing up records, grabbing a quick snack, and every so often sitting down. A dense forest of rainbow-hued paper fanned out from file folders on the wall, each color allotted a specific role—golden yellow transfer sheets, pink treatment sheets, baby blue bloodwork requisition forms. It was a straightforward system, but overwhelming until memorized.
The floor was industrial-strength linoleum that was always halfway between clean and dirty. Large puddles of blood, urine, diarrhea, or vomit were cleaned immediately, but smaller splashes were often forgotten in the hubbub of stabilizing a critical patient. Animal hair was everywhere, and it remained tucked into the corners of the room despite our efforts to clean it up.
The patients of the preceding few hours determined the smell of the emergency room. I learned the shockingly pungent, eye-watering distinction between urine from intact versus neutered cats. And I became adept at identifying the particular odor of bloody diarrhea caused by canine parvovirus.
I also learned a fundamental lesson not taught in any lecture: Listen to the technicians. Those who’d worked in the emergency room for years saved me on a daily basis. Their seasoned suggestions of a test to run or a medication to administer were invaluable to a clueless intern. The glaring inexperience of my first days as a veterinarian was nothing new to the team of senior doctors, residents, and technicians; a fresh class of interns stood blinking in the fluorescent harshness of the ER every June.
From the first day of orientation my position as an intern was firmly established. Interns ranked marginally above the students, but below almost every member of the veterinary st
aff. My hard-won title, veterinarian, meant little to the technicians, and less to the most senior veterinary specialists who headed up the clinical departments. If my name had not been embroidered on my white coat I am certain some faculty members would have called me “You!” for the entire year.
The residents were positioned between the interns and faculty. VHUP residencies typically lasted three years, and every clinical department from dentistry to surgery trained residents. The number for each specialty was based on the size of the department and their caseload. Internal medicine had four residents each year, while smaller services such as dermatology would take one every two or three years.
Internship success depended on getting along with the residents, second only to winning over the technicians. In many ways the residents ran the hospital. Regardless of specialty, they saw the most cases, worked the longest hours, and were the people to call if you had a problem patient. They usually remembered what it was like to be an intern, which meant that they were willing to lend a sympathetic ear, or hand, when things became overwhelming. The residents were my heroes, more accessible than the god-like senior clinicians, and close enough that I could imagine myself in their position.
I was still a year away from residency, but only a month or two separated me from the students I taught and supervised. The different structure of veterinary training in the United Kingdom meant that, at twenty-five, I was younger than most of the final-year students. And the bewildering adjustment to a new country made me feel even more immature. The novelty of my English accent muted some of the potential conflict between me, a naïve young intern, and the students who were paying close to $50,000 a year for enrollment at the University of Pennsylvania.
I understood the awkwardness of my position. When I was a student a few months earlier, I’d found the interns both helpful and confusingly annoying. Sometimes they were competition for performing basic procedures, a source of constant irritation when students were desperately wanting to try out new clinical skills. But interns were also good company on overnight ICU shifts, in which hours were occupied debating critical questions such as how hungry we’d have to be to eat cat food.
In the everyday high-paced bustle of VHUP it was easy to forget that we’d all—interns and residents—made a voluntary choice to be there. Unlike in human medicine, veterinary internships and residencies aren’t mandatory. Upon graduation I was free to practice medicine and perform surgery on any species, and I was one of only two in my class of almost one hundred who’d pursued an internship straight out of school.
I was lucky: I landed a coveted position at a highly regarded academic institution, which would pave the way for my future in veterinary medicine. I didn’t appreciate, at the time, how significant my year at the University of Pennsylvania would prove to be. I was solely focused on my overwhelming goal of survival—for my patients and myself.
Like all VHUP interns, I was assigned to a clinical service in the hospital, and every month I would rotate to a different department. I was always a week away from finding my feet on shifting ground; by the time I was comfortable in a particular department it was time to switch, and the responsibilities, caseloads, and expectations were different on every service.
During my first month, in the emergency room, I was left to my own devices between eight and nine each morning, when the senior doctors attended resident teaching rounds. I was the only qualified veterinarian in the ER for that excruciating hour, and my responsibilities included triaging and admitting new cases, and keeping an eye on the day’s ER patients. I spent most of that time hovering in the middle of the treatment area, silently praying for no new patient arrivals. My primary goal for the hour was to avoid anything remotely resembling the practice of veterinary medicine, and, when that wasn’t possible, to avoid killing anything. First do no harm was illuminated in neon, flashing in my head.
* * *
—
On a Tuesday morning in late June, the senior clinicians had left the emergency room. The bank of cages was gradually emptying of patients being transferred to their respective specialty services—orthopedics for broken legs, soft tissue surgery for abdominal masses and intestinal obstructions, and internal medicine for everything else. Residents came and went, leaving students and interns to transport patients out of the ER, along the corridor to the elevator, and up three floors to the wards. The sea of still-unfamiliar faces did little to calm my rising nerves.
I peered into the oxygen cage trying to determine if the dyspneic cat’s breathing had changed in the thirty seconds since I’d last checked. The cat’s coat was dull and spiky. She had not been grooming herself, and I had an urge to smooth her rumpled fur, to calm her jagged breathing with my touch, but I knew that by opening the cage I’d only make her worse. One of the technicians, Elisa, entered the emergency room. She was a few years older than me and was considered one of the more senior and experienced staff members. I felt wary of her. I had the distinct feeling that she was waiting for me to slip up.
“There’s a GSW coming in,” she said. “The police department called; they’re bringing it in. ETA ten minutes.”
GSW? I didn’t want to betray my ignorance, having already been caught out by HBC, hit by car, which we’d called a road traffic accident, or RTA, in England.
“It’s a big dog,” she continued. “Got in the way of crossfire. It sounds pretty bad, shot in the chest.”
I suddenly realized GSW meant gunshot wound. I looked at the clock and caught my breath—ten past eight—fifty minutes before the senior clinicians would arrive. Then I looked at Elisa. She was petite, pretty, always wore makeup, and managed to keep a manicure looking fresh all week. Her neat, brightly colored scrubs made me feel baggy and crumpled.
“You’re joking, right? I mean, dogs don’t get shot.” I laughed, sure that she was testing me, hazing the new intern. I’d almost fallen for it, too.
Elisa looked at me. She wasn’t smiling.
“No I’m not,” she said. “The dog will be here in ten minutes. What do you want set up?”
I had absolutely no idea what to do with a dog who’d been shot, or how to get back onto Elisa’s good side. This definitely hadn’t been covered at vet school.
“Sorry,” I said. “It’s just, we don’t really have guns in England, and I didn’t think a dog could be shot. Sorry.”
“We see them pretty often here, so you better get used to it,” Elisa replied.
“Great, yes. It’s good to see new things. What do you think we’ll need?”
I could only hope she’d come through. I relied on my plastered-on smile to hide the redness rising to my cheeks, and my white coat to hide the rapidly expanding rings of sweat under my arms.
“Well…” she said.
I smiled harder, looked at the clock: eight-sixteen; the dog would arrive in less than five minutes.
“Maybe we could set up for an IV catheter and hang a liter of fluids?” I said.
“Right,” Elisa said. “Do you want me to set up for a chest tap, too?” She’d thrown me a lifeline.
Chest tap? That meant I would be sticking a large needle between the dog’s ribs to drain blood from the thoracic cavity, or air if the bullet had gone into the lung. I’d seen it done, and I’d assisted a few times, but to do one by myself, with no other doctors around…I tried to remember the landmarks, what I would need to do, which rib space, how high up the chest wall to pass the needle. Elisa stared at me expectantly.
“Yes, that’s a good idea,” I said. “Hopefully, we won’t need it.”
While I was recalibrating my expectations for the next forty minutes, the page came in.
“Triage to the front with a gurney. Stat.”
Two assistants headed for the door of the emergency room grabbing towels and a gurney. I walked to the crash table where my new patient would land, my legs trembling. The edge of the
stainless steel was fringed with lengths of white tape ready to secure an intravenous catheter. Gauze squares soaked in dilute chlorhexidine scrub solution and alcohol sat in two small paper party bowls, ready for use.
Elisa finished setting up the chest tap and looked at me. “What size gloves are you?”
“Uh…small?”
“How about six and a half?” she asked.
I had the fleeting thought that no one at home was going to believe I was treating a dog with a GSW. Then the door of the emergency room glided open and a broad policeman, with—I couldn’t help noticing and then was unable to ignore—a gun strapped to his belt, bundled a large black dog through it.
“Over here,” shouted Elisa. And the policeman dumped the dog onto the table in front of me.
I looked down at my patient and noticed a smear of blood on the table, but I couldn’t see where it was coming from. The dog’s black coat hid the spot where the skin and muscle had been breached. He looked calm. His head was up and he seemed curious about the hospital, his personality intact despite the hole in his chest wall.
“What’s his name?” I asked.
“Hercules, I think,” replied the police officer.
“Where’s his owner?” Elisa cut in.
“He’s coming,” the officer replied. “He doesn’t have transport, so he’s coming by bus. Should be here in a half hour or so.” The officer seemed unconcerned.
My Patients and Other Animals Page 3