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Saturday, July 23, 2011

A Veterinary Student's Externship at Johns Hopkins Hospital

Guest Blog by Jennifer Morrissey, Cornell Class of 2013
Posted July 23, 2011
Ms. Morrissey scheduled her observing externship at Johns Hopkins Hospital during the summer between her second and third year veterinary college. She has a career interest in anesthesiology.
As I walked into Johns Hopkins Hospital on my first day of a two and a half week externship in anesthesia, to say I was worried is an understatement. Was externing at a human hospital a big mistake? Was I going to learn anything that would be valid in my own veterinary career? But when I reached the office of Andrea Collins, my coordinator for the externship, I was immediately relieved—her office was in the Blalock building.
Alfred Blalock was a surgeon at Johns Hopkins in the 1940s. He and his assistant, Vivien Thomas, perfected a technique colloquially called the blue baby procedure, in which the heart vessels in the affected infants were rerouted to assist oxygenation of the blood in the lungs.
Why was this story so comforting to me? Because the surgery was developed using hundreds of dogs, and finally perfected in a dog named Anna who became so famous that her portrait hands at Johns Hopkins University. A technique similar to the one developed for Anna is still used in veterinary patients today. It is also a procedure that we study in our first-year curriculum at Cornell. The simple name of the building (Blalock) reminded me that, at the end of the day, human and veterinary medicine are one medicine.
I had the pleasure of spending the next two weeks observing and learning from some of the most diligent and instructive residents I could have imagined. Every day was a learning experience with lessons ranging from how to conduct yourself in the O.R., to airway management and, my favorite subjects as an anesthesiology geek, pharmacology and physiology. The principles were all the same. Don’t touch sterile drapes! Know how to make sure your endotracheal tube is, indeed, in the trachea. Which drugs are best for sedating a patient? Beware polarizing blockers in a patient with kidney disease. Maintain fluid volume. When should we use colloids instead of crystalloids?

Veterinary student Jennifer Morrissey recently completed
an externship at Johns Hopkins Hospital in Baltimore.
Photo courtest of Ms. Morrissey.

As I rotated among a half dozen residents, I was reminded that medicine (whether human or veterinary) medicine is not just a science, it is an art. Some rules, of course, are written in stone. But I had the opportunity to discuss differing opinions among the residents. Should I start a blood transfusion now, or wait to check the hemoglobin level? Which opiate should I administer to this patient? And there were no wrong answers; it was just a difference among artists. 
It was in these artistic details that I came to grasp some of the important differences between human and veterinary medicine. The most striking difference presented itself on the second day of the externship. While chatting with a man to ease his worry over getting an epidural block, he grabbed my hand, looked me in the eye and said, “I’m not going to wake up from this, am I?”
It may seem obvious, but it is truly striking to realize that human medicine patients can talk. I was completely unprepared for this scenario! Cornell has, of course, educated me on how to talk to animal owners and trainers, and how to project serenity while working around patients. The fact that veterinary patients cannot talk is often taken as a challenge for diagnosticians. It also makes the projection of empathy a more physical practice - a petting hand, a soothing tone.
As this man looked at me, I became fully aware of how different it must be to care for other people. How do you soothe without lying? How do you emotionally separate from someone who is so much like yourself, who can understand your words? Over the weeks, I witnessed many more humbling experiences and watched as the residents dealt with each one with grace and kindness. 
I observed many other differences while at Hopkins. The precautions and monitoring of patients is taken to a whole different level in human medicine. There are also certain drug differences that exist between the two fields, ketamine being a major example. Unlike veterinarians, physicians also have to deal with the nasty 90 degree angle of the human trachea when placing an endotracheal tube―in supine position no less! 
But at the end of the day, the warm welcome and tutoring from the residents and attending anesthesiologists made me feel like I was among colleagues. I was extremely disappointed when my externship drew to a close, but I left feeling better prepared for both the art and science of one medicine.