Thursday, January 6, 2011

A Day in Private Practice

I recently experienced one of those days that illustrate the fun as well as the frustration of private practice. If you are not in the vetmed field, please excuse my morbid sense of humor at times; we can't help it, we develop it to keep ourselves sane! (Well, somewhat sane!!)

My day started with my running late. Having a menagerie at home means that there are certain things that must be done every day before leaving the house and, if any small thing goes awry, one will be late! This morning started with cat puke and the never ending race to stop the dogs from cleaning up faster than I can. This was followed by the diabetic cat not being in any of her usual spots so I had to put out an APB to find her and get her insulin administered. Finally, I frantically ran out the door to perform my last duty prior to leaving which is giving all the big dogs their morning meds. I have a few who are geriatric and don't hear well so, of course, one of those was sound asleep in his house and I had to go in and wake him after having my customary panic of whether he was still alive or had died in his sleep (yes, I know, sounds horrible but when they get to be in their late teens it is a constant worry). At last, into the truck and fly to work trying not to get a ticket.

When you start the day running late, you can never catch up. The morning was already falling in on my head by time I walked through the door. I threw my junk in the general direction of a counter top and went to work on the beagle who howls constantly that we are currently treating for lymphoma. For some reason, he tolerates certain people better than others and I am one of those so I grabbed a needle and syringe and pulled blood for a CBC quickly so we could send him out the door! Immediately, I got sucked in to taking care of the hospitalized patient that is technically my colleague's responsibility but my colleague was also running late.

No sooner had that patient been situated than we had an emergency walk through the door. Big dog little dog, my dog is dying, he's bleeding to death, etc. Yeah, two tiny puncture wounds on the shoulder, white dog so of course it looked terrible. Oh what a miracle worker (ha, ha)!!

Finally, down to the business planned for the day. I start examining all the surgery dogs and tell my tech to start pre-meds, get everything ready. Since being out of school, I've had one dropped pedicle. Two in a row that day and I'm not even sure why. The first one the suture just cut right through and, unless I'm She-Ra disguised as an ordinary person, I still can't explain it. The second one had to do with a defective hemostat that is now broken into pieces (temper, temper) and I probably shouldn't be admitting that just in case my boss sees this...

Naturally, this puts me behind in my schedule since dropped pedicles equal more time than usual to finish. The next dog just didn't want to get to a surgical plane of anesthesia. We spent far too much time fluctuating between the dog is okay, right? and could you please get her deeper so she stops spilling her guts out at me! Fortunately, we did not have a heavy surgery load for the morning but, with all the "complications," I wound up working well into lunch time to finish. I'm becoming spoiled to having lunch again after not for so long and thought I'd have 15-20 minutes to grab something and write up all the surgery charts prior to the first appointment. Alas, no, this was not meant to be.

This time, we had a real emergency. A septic puppy that probably had parvo. After spending quite a lot of time and not a small amount of money, the owners opted to euthanize and by that time the first 2 afternoon appointments were there, in rooms, and chomping at the bit. The afternoon was steady with no great mishaps until 5 p.m. We close (ha, ha) at 5:30 and the last appointment is usually kept at 4:30 to allow time to finish up and in case there is an emergency. Not this night. At 5, the guy comes in with his very large dog (90lbs) who has blood oozing from his rectum and cannot walk. 45 minutes later, he is still trying to decide if we should attempt to treat the dog or euthanize it. His wife finally came in from the car and talked to us, decided in less than 5 minutes to euthanize (I got the feeling she really didn't care) and left again. He still agonized with the decision.

After spending a little more time with his dog, he decided to euthanize but wanted to be with his dog. Don't get me wrong, typically I encourage owners to stay since I believe our pets deserve for us to be there for them when they die but I knew this one would not be good because the dog was so terribly dehydrated and debilitated. I began injecting into one vein after explaining the whole process, especially how quick and painless it was, only to see the vein blowing after about 1.5cc. Okay, I went to a different leg and had the same thing happen but at least it was enough for the dog to go to sleep. Now what? This was becoming a nightmare. I couldn't do a cardiac stick in front of the owner, besides, I didn't have a big enough needle for this dog (he was thick!) Finally, I persuade the owner to go and assured him that I would stay with his dog until it was gone (I think his wife impatiently gesturing to him was more stimulus than I, to be honest). After the owner left, in a last desperate attempt, I injected into the tongue vein (also not owner appropriate, can you imagine pulling the tongue out and sticking there while someone watched?) very slowly with strains of "This is the dog that will not die..." (Lamb Chops "Song that Doesn't End" hint, hint) running through my head. As he peacefully breathed his last, I started singing aloud much to the chagrin of my assistant who had stayed late to help.

And, no, the day still wasn't over. We had to bag the dog, avoid the diarrhea, carry him to the freezer (heavy!), and clean up the mess. Then I got to finish writing up my charts. Then I got to go home and take care of the kids (4 legged) and cook supper and.....

2 comments:

Fi from Four Paws and Whiskers said...

When I switched to full time teaching, a regular comment was, don't you miss being in practice. Short answer, easy answer, NO! Better holidays and no after hours ...
But I still spend three half days a week in clinics with students, and many vets admit envy when I am able to leave them to a hectic day, difficult ops, bagging diarrhea cadavers... Oh the fun! Quite takes me back reading it all..

Judy said...

Reading this post had me reliving many days like this in a clinic! On days like that it seems like the "good" (yeah right)stuff just keeps coming!