Thursday, January 21, 2010

Letter of Resignation

To Whom It May Concern:

Please consider this my letter of resignation from your program, from veterinary medicine, and, perhaps, from adulthood in general. I am thoroughly disgusted and fed up with the politics of the profession. I want to be completely clear in the statement that this decision has nothing whatsoever to do with the medicine. Yes, there are times in which the medicine can be frustrating and cases are lost that are difficult to swallow but it is the politics that are killing me.

Nasty politics that range from making decisions based on convenience rather than what is best for the patient. Politics that involve feeling as if proving yourself smarter or better than others dictates what decisions you make for your patient. Politics that require people to dance around the boss in worship rather than consider the needs of the patient. Politics that necessitate genuflection and kissing derriere or other methods in order to advance in your career. These politics are the source of the death of my professional career.

When did veterinary medicine become a study of "me"? At what point did we relinquish our devotion to our patients' needs in favor of our own petty whims? Do not misunderstand; I am not advocating having no life of your own or being a selfless martyr. I simply do not understand what happened to our priorities.

Initially I questioned whether I was asking too much of this institution and found myself comparing it to my alma mater. I tried to be reasonable and figured that since I have been out of school for quite some time it was likely that I was viewing my time as a student with "rose-colored glasses." Recently I visited again, this time in the role of a doctor, and found that I was not disappointed. It truly does work better there. So what has happened here???

I was asked if I was burned out from working such long hard hours and the simple answer is no. Burned out is not the word I would use to describe myself. I am disappointed and depressed. I feel as one would feel when their absolute idol has crumbled and fallen to the ground in front of them, proving to be merely human after all. Perhaps I have asked of and expected too much from my profession and am now witnessing the fall of unsustainable expectations. Perhaps there really is an idealist beneath my cynical facade that is being forced to face the reality that nothing is as it should be. I don't know exactly how to explain what is going on right now other than to say that I feel suddenly, devastatingly, completely depressed and disappointed.

Unfortunately, this is not the only place in which I've witnessed this phenomenon. Since graduation, I have worked in three different places, three different settings. First in mixed animal private practice, second in specialty private practice, and lastly in a university setting; in each of these I have witnessed this disturbing tendency. I have now reached the end of my tolerance and I quit. I do not quit the patients - it is not their fault that this idiocy reigns - but I quit the situation. No residency for me; I don't even want it anymore because at this point I cannot imagine that it could possibly be any better. Veterinary medicine adieu. It is time to find a new means of making a living as I cannot tolerate this blasphemy any longer.

So anyone want to buy a cookie?

Monday, January 18, 2010


It seems as if all of my ER shifts go in themes. You know, I'll see a ton of GDV's or hemoabdomens or something just keeps recurring. This time it is the rotation o' death.

I started out with a bang the first night I was back with a severe pancreatitis that seemed reasonably stable all night until 6:30a.m. when he apparently had a pulmonary thromboembolism, started breathing heavily and expired within about 15-20 minutes. This has continued with nasty cases throughout the week. On Friday morning, I got to spend 1.5 hours talking to a lady about letting go and considering euthanasia for a dog that we've been seeing here for years (I'm always lucky to catch those.) It didn't help that the dog reminded me immensely of my little Choo who died last December shortly before Christmas.

I finished the week with a sigh of relief and a lot of chocolate support thinking, "Finally, the week is over; surely things will get better next week." For those astute readers, I'm sure you are just expecting the other shoe to drop and you would be correct.

Tonight, I admitted a very sad case whose ultimate outcome I am completely certain of but whose owners want to try everything possible. The dog was completely normal until after the owners had been away for 2 hours at church at which time they found him staggering and acting drunken. He had been outside on a tie out while they were gone. He drank a whole bowl of water then promptly threw up. They brought him in to me and my first thought was ethylene glycol toxicity until proven otherwise.

With questioning, the owners stated that, yes, they had changed the antifreeze in their car the day before but they didn't think he had gotten any although a small amount spilled. I told them that was my top concern and that we would run some tests to try to find an answer. Being past the probable window of getting good results for the specific test I ran a baseline CBC/Chemistry and discovered the dog was in renal failure although he was also extremely concentrated at a PCV of 72% so he had some pre-renal component. I had started shock therapy and he received a full 3 liters of fluid bolus before he seemed to stabilize at all. We attempted to get a urine sample and found that he had approximately 0.5ml in the bladder. For those medical types I'm certain the warning bells are screaming. Further confirmation of my diagnosis came from the presence of too numerous to count calcium oxalate monohydrate crystals in the sediment.

At this point, he is rehydrated and back to normal temperature (he was severely hypothermic on presentation). We administered fomepizole, the antidote for ethylene glycol. We have tried a 20% dextrose CRI in an attempt to induce osmotic diuresis without a drop of urine produced. We are now adding furosemide (lasix) and a dopamine CRI to see if that will work. If it doesn't, I have no more choices and the dog has no more chances. I'm not holding out much hope.

Antifreeze is a deadly toxin for all animals. Apparently it has a sweet taste and is attractive to pets to drink and it only requires a very small amount to induce renal failure. When you reach the point where the kidneys have stopped producing urine, particularly in the face of the volumes of fluid we are pouring into this dog, it is extremely bad juju. Our best chance of survival post-antifreeze ingestion is if the event was witnessed and medical attention sought immediately. When it has been long enough to see crystals, we are already starting out behind the eight ball. Realistically, this dog will not walk out of the hospital and it's only a matter of either time till he dies or his owners making the decision to quit. I have already had the serious talk with them and if he fails to make urine with the addition of furosemide and dopamine there is really nothing else to do and I will recommend that they choose humane euthanasia. At least that is an option that we have in vetmed...

Friday, January 15, 2010

We Wear the Mask

Paul Laurence Dunbar (1872-1906)

We Wear the Mask

WE wear the mask that grins and lies,
It hides our cheeks and shades our eyes,—
This debt we pay to human guile;
With torn and bleeding hearts we smile,
And mouth with myriad subtleties.

Why should the world be over-wise,
In counting all our tears and sighs?
Nay, let them only see us, while
We wear the mask.

We smile, but, O great Christ, our cries
To thee from tortured souls arise.
We sing, but oh the clay is vile
Beneath our feet, and long the mile;
But let the world dream otherwise,
We wear the mask!