Tuesday, May 18, 2010

72. Veterinary Internship and character references

Story 1: End of a 3-month internship

May 18, 2010 is the last day of internship for Teresa. Three months of 6 days of seeing practice had passed by so fast. This is the forgetful intern who had caused me great embarrassment in the case of saying that the weight of a 3.6 kg cat as 2.6 kg. On this last day, I told her that I expect her to do well in her first-year veterinary studies and not have to re-sit examinations.

Our last case study was the discussion on the X-rays of a Cocker Spaniel who had swallowed stones and was operated by another vet. I had asked the owner to bring in the CD of the excellent X-rays taken by another practice. "It would be a simple veterinary radiology case," I thought. "Just show where the two pebbles are located. Either in the stomach or intestines."

Teresa downloaded the images into the desktop. I was surprised that the positioning of the "R" and "L" were not in their usual position as shown in veterinary radiology books and in almost 100% of small animal practices. Vets are used to seeing the "R" on the left side of the X-ray and "L" on the right side. In the original X-ray, the "R" was on the right side. So, a vet who does not check these two letters, would naturally and incorrectly diagnose that one pebble is inside the stomach and the other is in the small intestine.

I said to Teresa: "Veterinary life is always full of surprises. Veterinary medicine and surgery can be extremely stressful and challenging. A human doctor needs to know one species. A human surgeon specialises in one system, e.g. the alimentary system. A vet needs to know various diseases of many animals and is expected to operate on all body systems from the nose to the tail. It can be overwhelming for a new graduate."

I explained to Teresa that a vet also needs to have an excellent knowledge of veterinary anatomy in studying X-rays. "If you look at the original X-ray, the one with the lateral view, you will think that one pebble is inside the stomach," I said. "It is actually outside. You will need a ventro-dorsal view to confirm it.

"From the dorso-ventral view, you can see that the pebble is outside the stomach in the small intestine if you mirror the image of the original X-ray. If you don't mirror image, you will think that one pebble is in the stomach and one is in the small intestine. This is because almost 100% of the vets view the X-ray with the "R" on the left side of the X-ray. The stomach is located on the left side where the "L" will be shown in the usual X-ray. In this X-ray, the "R" is on the left side and if the vet does not have an excellent knowledge of veterinary anatomy, he or she mis-diagnose the pebble as being inside the stomach. If he operates, he will find no pebble."

I gave her a tip. "Just use your fingers to palpate the whole stomach before you incise it and you will feel that there is no stone. Take out the small intestine and palpate the length. Don't just incise the stomach based on the X-rays. This is the second check."

Teresa had no idea what I was talking about as she had not studied veterinary anatomy but she is an intelligent girl and will know what I was talking about.

"What is that black circle inside the stomach?" Teresa asked. "It is stomach gas." I said. "It is not a foreign body."

The original X-ray before I made this mirror image to teach the intern would have confirmed that the pebble was in the "stomach". The he stomach is on the left side in the usual X-ray, but this original X-ray was not the usual one. The "R" was not to the left side in the original X-ray
"You have to know veterinary anatomy very well," I said to the intern who tested my patience with too many questions. "Otherwise, you will look at the X-ray and think that the pebble is inside the stomach. Assuming you have only one X-ray, the lateral view. You still don't have to worry. You use your hand to feel the stomach. Such a large pebble can be felt. Do not incise the stomach first."

I don't know whether Teresa would remember this last case. But with 3 months of solid attendance at 6 days a week including Saturdays and Sundays, she must have had picked up a lot of knowledge. I wished her well. She was one of my best interns and one who caused me grief and great embarrassment in the case of
FORL in the Burmese cat. That is why some Singapore veterinary practices don't accept interns.

Story 2: Character referee sabotages the prospective intern's prospects

On this same day, the aunty of a prospective intern who had taken a lot of trouble to e-mail me phoned me. I was already fed up with this aunty who did not keep her appointment to meet me last Friday. During the conversation, I asked whether she could get a character reference who is not the mother for me to interview. The aunty said: "It does not matter. My niece can come to Jakarta when she comes back from the U.S."

I just could not believe my ears. This aunty was supposed to be the niece's character reference. She did not turn up after making an appointment last Friday. And now, she actually sabotaged her niece's prospects for internship. This was really weird. "Your niece has excellent grades and is the one who approaches me for an internship," I told the aunty in a loud voice. "She is an intelligent girl and has got her American professor to write her an excellent testimonial. Now you talk as if I am the one desperate for her services!"

I did not want to continue the tele-conversation with this aunty as I was really fed and I had plenty of things to do. The relative was actually sabotaging the niece's future. First, she did not turn up for her appointment to support her niece. Now she made casual remarks about internship. A take-my-niece as an intern or leave it, old boy!
The aunty must have thought that veterinary internships are a dime a dozen! Her niece has excellent grades and everybody will accept her as an intern. There is something not right with this thinking.

From this episode, all prospective veterinary interns should be careful as to whom they ask for help in getting character references. Never ask somebody who is not really keen to help. You really can get sabotaged. And it is an unpleasant experience for me to talk to such referees.

Updates and pic are at www.toapayohvets.com

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