Lateral view. The mirror image of the original X-ray. Most vets are used to seeing this positioning	Original X-ray

"From the ventro-dorsal view (picture, below), you can see that the pebble is outside the stomach in the small intestine. This is because I have made a mirror the image (picture below) 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."

Ventro-dorsal view. The mirror image of the original X-ray. Most vets are used to seeing this positioning	Original X-ray. I would use this for the final year examination of the 5th year vet student if I was teaching vet radiology! It will test their grasp of the canine veterinary anatomy.
Mind your "Rs" and "Ls"

"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 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.