Just in case anyone was wondering why I haven’t written a post in a while, it’s because I apparently became the victim of a months-long conspiracy two weeks ago. Ever since I got my clerkship schedule finalized, I’ve been nervous about my current rotation, which is PDI 630: Diagnostic Pathology.
As more and more of my friends finished this rotation, I received more and more lies about this clerkship.
“Don’t worry, Ryan. It’s one of the more laid back rotations!”
“Pathology is the best! You’re out by five nearly every day!”
“You can totally have a normal life while on this rotation!”
“We only necropsy unicorns in between trips to the beach at sunset LOL!”
None of these falsehoods could be further from the truth. Pathology has been the bane of my existence for the past fortnight. Allow me to explain why. This is how pathology is supposed to work.
At Michigan State University, our pathology rotation is split into two portions: Clinical and Gross Pathology. Clinical patholgy entails spending 8am – noon at a classroom / microscope lab in the vet hospital. Each morning we practice reading blood smears, examining cytologies, preparing our own slides, reviewing pathological processes, and interpreting lab values from actual cases.
After lunch, we head over to the nearby Diagnostic Center for Population and Health (DCPAH) for gross pathology. This is where we receive dead animals from clients and the hospital. We work in teams to perform necropsies (animal autopsies) and take samples for tests so that we can determine why these animals died. We wrap up around 5pm and head home.
As I should have suspected, cutting open dead animals and memorizing pathological processes isn’t as glamorous as I was led to believe. Allow me to list the reasons why this is the case:
- We received ridiculously little necropsy training. After lunch on our first day, our supervising pathologist explained to us that the first day of necropsies is supposed to be very slow. We had two animals waiting for us on the necropsy floor, which was very doable (the average is probably 1 – 3 animals per day). The pathologist wanted to give us a powerpoint on how to do a necropsy, do the first animal himself to show us the actual process in person, and then let us work together on the last horse.
This plan promptly fell completely apart when we ended up with nine freaking animals coming through the loading doors one after the other. The most animals we ever had on a single day after this was five. What should have been a pleasant stroll through Dissection Town quickly morphed into a sprint through Massacre Metropolis.
The powerpoint was scrapped and the pathologist flew through the demo at breakneck speed. As he tore a cow apart with what must have been the world’s sharpest knife, our instructions amounted to, “You want to cut the animal and check the shit inside. Then cut the inside shit and check for more shit have fun with it!” Side note, the lead pathologist during our first week might have been slightly insane.
We split off into pairs and tore through as many animals as quickly and improperly as we could manage.
Pro doctor tip: If you can’t get it done right, get it done fast!
For reals though, it was a disaster. We didn’t know what samples to grab or how to take them, we cut the animal open on the wrong side (stay left lateral, baby!), and worst of all one student got splashed in the mouth with some fecal fluid. That leads us in to the next fun point.
- Two of my classmates probably got Crypto. If you’re a vet student, you probably just shuddered in fear. Cryptosporidiosis is probably the most common infection that vet students get from animals. It’s caused by a protozoal parasite found in the fecal material of infected animals and can be transmitted easily to those who work on them. The result is usually 1 – 2 weeks of unbelievably massive diarrhea and intense abdominal pains. We’re waiting on the fecal test results from one of my classmates to determine if they were actually infected by Crypto, but all the signs point to it. They both missed two days of this rotation, and one of them lost twelve pounds in less than a week.
You tiny bastards.
Fun side fact, this likely Crypto infection made me absolutely furious at human medicine. You diagnose a human or animal with Crypto by looking at their feces under a microscope. This is something that vet clinics routinely do and it usually take maybe a half hour to prepare a slide and read it. How long did the student health center that one of my classmates went to say it would take? Five days.
How the fuck is that possible? Well apparently most human doctor’s offices don’t do fecal examinations in house. Instead they send them off to labs. I think it’s weird to send out something so simple, but even if that’s the case, how does it fake five days? I can understand one for shipping, one for preparing and reading the samples, and maybe another day for wiggle room. But five? And the icing on this crap cake is that the doctor my friend went to processed the sample wrong. So now it’s going to take even longer to determine if we have a Crypto outbreak on our hands. It’s idiocy like that that leads to shit like this.
I fucking hate these shirts.
I may be pissed off about that bungled test and doctors outsourcing more stuff than is necessary, but I’m not going to say vets are better than them. Veterinarians (and a lot of my vet student classmates) complain a lot that they’re not respected by human medical professionals. If you feel that way, maybe you shouldn’t start insulting them back. It’s time for the divisiveness between DVMs and MDs to stop. We all work hard, we all learn a lot, and we need to work together if we’re going to stop the spread of communicable diseases that affect both humans and animals. So there’s my olive branch, MDs. I’d appreciate it if you could speed up the fecal exams, but we’re all still doctors.
- Really weird biosecurity. Wow, we really took a step out with that fecal exam stuff. Let’s get back to the bizarreness of this rotation. When my friends felt able to come back to DCPAH, the head of the facility talked to them to try to determine how they might have gotten Crypto. After all, we do adhere to strict biosecurity. We have to wear hair nets, gloves, goggles, make sure no skin on our arms are showing, and wash our hands three times during the process of getting out of our scrubs and changing back into our normal clothes. We’re also not allowed to bring any papers or tools out of the necropsy floor. With all of that, how could two students have possibly gotten sick?
Maybe because we don’t wear masks?
I don’t understand this. We have this complex biosecurity protocol and go through so much effort to protect our arms, hands, eyes, and hair, but we don’t do anything to protect the giant freaking hole on our face that we open every few seconds to talk. When us eleven students unanimously voiced this concern to the DCPAH director, he was stunned. It wasn’t just confusion, he seemed almost disgusted by the idea. I have no idea why.
It must be the $0.08 per mask cost.
- Necropsies are less elegant than I assumed. I really doubt that most owners understand what happens to their animals when they submit it for a necropsy. Now I am not in any way disparaging its usefulness or suggesting that owners refuse one simply for the “gross factor.” Necropsies are incredibly important diagnostic tools. But I also have no problem letting people know what actually happens to their animals when they request a necropsy and letting other vet students (and future ones) know what to expect. I’ve tried to find an accurate representation of what it’s like to walk out on the necropsy floor with knife in hand for the first time, but nothing really did it justice. This is the closest I could manage.
It needs to be about 20% bloodier.
Here’s the general necropsy process. We make skin incisions around one of the front and one of the rear legs. We cut through the hip joint capsule so that we can splay these legs out. Then we cut off the skin and muscle on the animal’s side (lateral body wall). We crack open the ribs and remove them, allowing us to see the abdominal and thoracic organs nicely. After that, we remove the “pluck”, which means cutting out the tongue, trachea, esophagus, lungs, and heart. We examine all of these organs for abnormalities, then remove the GI tract. After checking the remaining abdominal organs for lesions, we move onto the worst part.
For small animals like dogs and cats, we need to cut open all of the intestines and check inside for any injuries or parasites. This means scraping out a ton of digested food and full on poop. Even worse is when you stumble across a half-foot long tapeworm, which I had the pleasure of doing last Thursday.
We wrap things up by cutting off the head, peeling off most of the face, and getting the brain out with a saw.
It’s such a weird thing for me to describe because it just comes so naturally to us by the third year of vet school. The only part that ever disgusted me was having to sift through intestinal feces, but I still did it with only mild irritation. I jumped back when I realized I was grabbing a nearly dead tapeworm, but I was still able to begrudingly return to work. Nothing else phased me or anyone else in our class. Not the cutting off heads, not the peeling faces away, not having a gallon of intestinal fluid pour out of a bloated abdomen, not even sifting through a literal pool of blood in the thoracic cavity to find the lungs and heart.
We all were pretty much desensitized to this stuff by the end of first year. So that’s one thing you should know if you want to be a vet but are terrified of blood and gore; you’ll get over it. Trust me.
- An Enormous Workload. All my previous points were about gross pathology. Despite those issues, I do enjoy working on the necropsy floor. It’s a heck of a lot easier to cut dead stuff apart then it is to heal living things. But clin path? I think it’s more important and relevant to what I want to do in practice, but my gosh do I hate it. It’s not the material, it’s how much freaking work we have.
Remember that we’re spending at least eight hours working on an average day. On top of that, a typical night’s homework involves coming back to the lab to answer questions on 2 – 3 slides and reviewing old lectures to answer “learning objectives” that we are constantly given. Of course, we’ve also had assignments where we need to research different diseases and toxic compounds and present them to the class. Then there’s the take-home mid-term exam that we worked on during the second week and the take-home final exam we were just given to work on for the last week. Those consist of slides and a case full of lab tests that we need to evaluate. The mid-term took us all about 6 – 8 hours to do and the final is even longer.
But just because we have a take home exam doesn’t mean we miss out on the fun of an in-class exam. We’ve got to study for that too. I also like to organize my notes at least few nights a week so I don’t just have a jumble of crap in a notebook. All of this means that we’re usually spending at least two hours a night on homework / studying and around 4 – 5 hours a day on weekends. I’d guess we’re all spending about 55 – 60 hours a week working.
That is certainly doable, it’s just draining. And while I spend a great amount of time complaining to my classmates, I do know that this is important stuff to learn and I’ve been putting in as much effort as I can. I just love to mitch about it, that’s all.
- Infuriating Subjectivity. The last point I want to hit is one of the most frustrating. Like I mentioned before, there’s two major points we hit in clinical pathology: analyzing labwork and examining slides. Neither is easy, but the labwork is simpler for me because it’s pretty objective. It’s like putting the pieces of a puzzle together. You find the abnormal values, look up or remember the different mechanisms that cause them, and assemble those facts together to come up with a likely disease. Here’s an example of a complete blood count, which is one piece of lab work we commonly deal with:
If you’re a not into veterinary medicine or are an aspiring vet, don’t feel bad for this making zero sense to you. These things might as well have been in Wingdings when I first dealt with them.
Looking at slides is different. You have to train your eye to tell subtle variations in different cells apart. For me at least, it’s a lot harder to do that than to memorize the mechanisms of different diseases.
The big cell on the left is a segmented neutrophil because it has focal constrictions. The one on the right is a band neutrophil because it has smooth edges and parallel nuclear sides while it doesn’t have focal constrictions. Apparently this should be obvious but it often isn’t. These are supposed to be clear cut examples of these two different cells and it’s still difficult for me. My friends and I often throw up our hands in frustration and have to walk away from the microscopes for a while when we start seeing cells that aren’t so “obvious.”
It’s been a trying semester, and this rotation has been more stressful than any other. Luckily I have a three week vacation up next. I can’t wait to take a break from vet med and chill with my girlfriend, family, and friends for a bit. If you are going to be dealing with a pathology rotation in the future, my advice is to realize that it’s probably going to suck. Keep on top of the work as best you can, hope that you’re with a good group of classmates, and get through it together. And just remember, it’s only three weeks.