I'm back

Sorry, I haven't written in a while, I have been busy...as well as sleeping after my shifts, waking up, and then doing the whole thing over again, for days in a row. My last two days have been on shift, on the floor, 12p-12a. Monday was nice and slow, got out of there I think at 1:20a or 2a. Yesterday, absolutely horrible. At one point we have 5 Triage Stats in at a time-2 on the tables and 3 laying on the floor, all trying to die!! I believe only 1 or 2 lived. We had a dacshund who had gotten stung by a nest of bees and was in anaphylaxis (tachycardia, hypotensive, v/d, hypothermic....a mess....I believe he made it) I dont know because I had a Germand Shepherd who had come in, unproductive retching - you think bloat right? Yeah well what didn't fit the picture was that the abdomen was really low slung and there was a fluid wave - although the dog was definitely unproductively retching, salivating, aspirating and basically dying in my hands. Hooked up ECG, blood pressure - tachycardia (200) and hypotension (50!!!). Bolused 1L P-lyte, HR down to 180 (still not good) and BP came up to 100 (ok). Tried to pass nasogastric tube because quick ultrasound probe did show a huge fluid filled stomach--also fluid in abdomen (uh oh...rupture??). No such luck on the NG tube....just severe epistaxis (nasal bleeding) all over. Plus dog is aspirating his own saliva at this time and crashing. So give propofol and intubate and take over breathing. Pass orogastric tube and get off large amount of yellow slimy fluid--yuck. Quick other look with ultrasound probe shows fluid in stomach and a mass attached either to stomach or intestines -- bad news -- dog needs surgery right now -- final decision - takes a while but dog is 10 years old and very unstable - owners decide to euthanize, which is not a bad choice. G shep with abdominal mass and free abdominal fluid is never a good thing!! So that was that stat. Then had a Golden come in who had collapsed and then arrested in car ride over...CPR but no luck...pronounced dead. Another golden, weak, collapsed, pale pink mucouc membranes, muffled heart sounds ... ECG shows electrical alternans (varying height of the QRS complexes) ...pericardial effusion? Why yes it is...confirmed by ultrasound probe...uh oh and a large heart base tumor as well as right atrial tumor as well as either large blood clots or tumor extension into the right ventricle....BAD NEWS!! Owner can't let go, wants us to try to stabilize so she can have at least one more day with her...knowing that we may kill her just tapping the pericardium. But, we do it, pull of 300mls of blood from pericardium and there is a lot more but can't get to it because of all the fibrin and the large mass. Bolusing P-lyte (1L) and giving pain meds but heart rate remains 180, pulses remain weak, dog is also poorly oxygenating (88% Pulse Ox). Go to have long talk with owner, dog is 14 years old, this disease has poor prognosis, with intracardiac mass, surgery not option anymore...she cries a lot and then finally decides it is the dogs time and we euthanize...with her present and hugging the dog bawling the whole time...i hate that..makes me wanna cry! Sad story... then she has to go tell me she lost her huband about a year ago and dog is all she has left both as companion and also to remind her of him....now I understand the need for us to try to stabilize the dog, however despite, sometimes it is just time and in Vet med we have the great luxury to stop the suffering which can be a great thing in certain cases. Had to pug puppies - just born - with body wall open and intestines outside body wall - yikes - would need surgery and probably wouldn't survive anyway or would likely have other genetic abnormalities as well (although did not have cleft palate or atresia ani)...euthanized both of those. Had a very sick, painful abdomen (pancreatitis???) cat...fluid, rads, abd ultrasound (which did not get done), blood work which showed sepsis...started on antibiotics...ultrasound was set up for today. Had yellow lab puppy that got bit by other dog in house...doing surgery after shift over...had to place two drains...one wound under chin - could see masseter muscle just demolished, could see salivary glands, could see nerve branches that luckily are intact!! Bad, bad wounds....he will probably be ok but jeepers...dont let the those dogs play together anymore. Had a bunch more as well but honestly cannot remember at this time. My total time for my shift last night? 21 hours....I am almost to 24hrs!!! Julio, one of the other residents...he has been away, just got married...said to me the other night "I am suprised to see you all still here, I thought for sure someone would have quit by now!!" Yep...nice internship I ended up in huh? Has a history of losing interns....WELL I CAN SEE WHY!!!!!!! If I wasn't the type of person that I am: perfectionist, afraid to disappoint anyone, determined as heck when I set my mind to something....then I would so totally bring my scrubs and coat in, drop them off, and say so long...but I can't no matter how much I dream of doing it!!! This is hard, it is hard to keep up spirits, especially coming home to no one but myself, having no one to talk to about things...basically crying by myself. I am trying to not let this job turn me into a cynical, depressed type person...I have to grab tight to that tiny light at the end of the tunnel...know that at the end of this year I can walk away from this, hopefully a better clinician, stronger person...and definitely not look back..move on with real life...get a real job and get paid...live a normal family life finally!!!...and smile!! Always smile...no matter what is going on in your life...find something every day that makes you smile. Leave work at work...work is your rubber ball...it can be dropped and not damage...so go ahead and drop it when life seems overwhelming so that you can easier hold your precious glass balls. Ok...I need to go grab some food and then head to that darn clinic again for rounds.