You never forget your first…

His name was Ali, as in Mohammed Ali. He was a handsome 1½-year-old tan and white Boxer with a sweet and playful disposition and a ton of energy crammed into the tiny makeshift exam room. Though Ali was only one of dozens of dogs evaluated at the Southside Healthy Pet clinic that evening, I’d forever remember him as the most exceptional dog I’d ever met, because Ali was the first “real patient” of my veterinary career.

The Southside Clinic was a veterinary student run “well pet” clinic offering low-cost exams, vaccines, and preventative medicine to pet owners demonstrating financial need in the community my veterinary school resided in. Ali’s owner brought him in for a recheck examination and booster vaccines, and on that particular evening, I was entrusted to obtain his history and perform a physical to assess whether Ali was healthy enough to receive his scheduled vaccinations.

As I began my systematic approach to his exam, I experienced the same anxiety I’d encountered during the times my mind blanked while answering routine questions on a final when I was sure I’d known the correct choices not more than ten minutes prior.

I’d previously practiced performing physicals numerous times; on my own pets, the friendly dogs and cats from the local shelters, and on my colleagues’ critters. But the challenge of doing the same task on an actual patient with an actual owner holding the other end of the leash was an entirely new experience for me.

I felt unprepared and ill-equipped for the task. I was sure I would forget to examine some crucial aspect of a critical body system. I worried I would miss a heart murmur or an abdominal mass or lameness.

I was paired up with a second year student who restrained Ali while I struggled to complete my tasks in an awkward and completely non-systematic fashion. Fortunately, both the dog and the student were exceedingly patient with my clumsiness and I was grateful for my partner’s assistance in reminding me of the things I should be looking for.

Ali’s exam was rather unremarkable (a term that, when applied to a medical record, denotes signs of health rather than implied mediocrity), but I’d discovered some sores and redness along the skin between his toes. The lesions weren’t noted during his exam the previous month, but the senior student had noticed similar red “bumps” between Ali’s shoulder blades during that previous visit. Those lesions had since resolved, but given the appearance of dermatologic changes in two distant anatomical locations, I wondered if unremarkable wasn’t the best term to describe Ali’s status.

But what was I supposed to do about it?

I consulted with the senior student, who made a suggestion based on her knowledge, but I wasn’t confident that it was the correct plan for Ali. The two of us spoke with the veterinarian supervising the clinic and he presented several potential diagnostic and therapeutic options for me to consider. Together, we discussed the pros and cons to each approach. I listened attentively, eager for instructions on how to proceed. More than a few moments of awkward silence passed before I realized I wasn’t going to be told what to do next.

Those passing seconds are etched in my mind, as they represented the first time I was treated more as a doctor and less as a veterinary student. The shift in responsibility lacked fanfare, but was palpable nonetheless. I’d need to stop thinking of myself as a task-oriented individual. I would need to learn how to become comfortable with taking charge of my patients’ care.

I quickly learned that the point of this clinic was not to be perfect, but rather to apply my flawed skills and imperfect knowledge in a “real world” setting. This was the time to make mistakes because I had backup available during every step of the process.

I reentered the exam room with increased bravado and assuredly discussed my findings and recommendations with Ali’s owner. I drew confidence from the reserve supplied by the staff veterinarian and his surety in my capabilities. A plan was set into action based on my conclusion as a primary caregiver rather than an intermediary whose role is to enact orders from someone else.

Looking back, Ali’s case was a bit of a no-brainer, but for a “first veterinary patient” I’m still inspired by the experience and what it represented for me in my educational process. I’d only been a veterinary student for three months, but I’d already begun the subtle process of transforming myself into a doctor.

Patients such as Ali made that transition all the more wonderful each time I encountered them.


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