Sunday, April 28, 2013

The Impossible Dream

"To dream the impossible dream
To fight the unbeatable foe
To bear with unbearable sorrow
To run where the brave dare not go

To right the unrightable wrong
To love pure and chaste from afar
To try when your arms are too weary
To reach the unreachable star

This is my quest
To follow that star
No matter how hopeless
No matter how far
To fight for the right
Without question or pause
To be willing to march into Hell
For a heavenly cause

And I know if I'll only be true
To this glorious quest
That my heart will lie peaceful and calm
When I'm laid to my rest

And the world will be better for this
That one man, scorned and covered with scars
Still strove with his last ounce of courage
To reach the unreachable star"

I have been exceptionally moody lately.  Normal for me is to be somewhat moody with a slightly depressive tendency but with the strong capability of hiding this from all except those who know me too well.  For whatever reason lately I've just been moody.  For instance, yesterday I was grumpy and was taking sarcastic potshots at anyone with whom I interacted.  Today, I've been mostly fatalistic but with a streak of idealism hence I've been randomly bursting into the above song (only when I'm alone, mind you!)  

That song ranks pretty high on my favorites list.  I think it has partly been on my mind because I managed to partially solidify why I'm so driven to do rescue stuff with the animals.  Although I cannot explain the wiring, I have always wanted to "make things better" ranging from the simple clean up of things to the complex save the world.  My compromise illustrates and would seem to support the idea, expressed by different people in slightly differing ways, that a cynic is a frustrated idealist.  I've realized that changing the world to make it better (even my small slice of it) is impossible.  I can, however, change the world entirely for some unwanted, unloved, and uncared for animals thus making their world better.  At least there is some sense of accomplishment in this rather than the perpetual frustration associated with changing the whole big world and making no progress.  Or, for that matter, of trying to make tiny improvements in the workplace only to fail miserably.  The animals at least appreciate my efforts and I experience a sense of satisfaction.  It's rewarding; unlike most everything else in life which leads to an unrelated comment.  Once again, I've had it hammered in my head how seldom actual hard work pays off.  You bust your butt and are lucky to get a mere thanks while someone else who is prettier, more charming, knows the right someone, or has the money gets promoted or chosen or whatever i.e. gets the reward.

The effect this has on me as a somewhat boss is that I strive to be rigidly fair and not reward the undeserving but those who work hardest.  Not that this does any good since I'm not and never have been in a position to have the final say and no one listens to my input...and there's only two, maybe three, people who listen to what I say at all.

At the moment, though, I'm dreaming the impossible dream and gearing up for battle with life. The depressive reality is that I'm probably fighting windmills...

Monday, April 22, 2013

Insanity, Stress, and Getting Old

I'm definitely getting old.  There seem to be more aches and pains present every day.  I get angry with myself all the time now when I wind up in the floor doing an exam (which is totally normal for me and always has been) because suddenly I realize that I have to get up again, preferably gracefully and modestly, given there is a client present.  I can no longer get away with skipping a day at the gym then just picking back up where I stopped.  I also have to force myself to be more careful to take my vitamins and joint supplements, particularly since I don't tolerate pain medications well.  The dogs and cats feel heavier than they once did and I've been idiotic enough to have kept those two "horse puppies" that I found...

I've always felt much older than the people around me in my head but, let me tell you, it really is all down hill after 30!

At work, we have a volunteer who wants to be a tech (yuck, yet another who wants to play with the puppies and kittens without really having the drive for the profession - sorry, I'm a tad bit done with all the tech wannabees we've seen lately).  I call her Nibbles because she is constantly eating.  Of course, she's also one of those teeny people who never gain weight as they ingest 2-3 times what I eat while I gain 10 pounds just from smelling food.  This girl has no concept of polite behavior.  On the food note, she actually took part of someone's lunch while they were eating it and had stepped away to answer the phone.  We're all getting a bit food aggressive...  She also sampled pieces of Ghirardelli chocolate then threw it away because she didn't like it!!!!!  That is grounds for hanging in my opinion!!!!  Wasting what is perhaps the best chocolate on earth.  Death to all chocolate wasters!!

On a good note, she does provide a person for those employees that are never happy unless they have someone to be mad at...  Not sure if that makes the stress she adds worthwhile.

If you abide by the definition of insanity being doing the same thing over and over while expecting different results then I've been hard at work proving my insanity again.  For those who know me, this sounds weird because y'all have seen how organized disorganized, predictably unpredictable, and studiously random I am, but I hate clutter!!  And work has been so bad lately mostly with things not being put away where they belong but just shoved somewhere for the moment.  I re-organized the storage closets....again....

Sadly, home is as bad and worse with my mom and her issues.  I've fallen off on my cartoons, creative writing, and reading for entertainment lately for lack of a "room of one's own" so to speak.  But I have added yoga to my life to help with stress.  Just try to imagine how bad I'd be if I didn't go exercise, have yoga, have chocolate, and have the kids to keep me sane.  Bwahahahahaha!!!!!!!  Scary, isn't it?!?

Sunday, April 21, 2013

Trust and Delegation

I've never been the trusting type in part, I'm sure, because I learned very early that you couldn't depend on people.  Your dog, your horse, and your cat, yes, but not other folks.  People keep telling me I need to delegate responsibilities more to help decrease my stress level but how can I when 1) I already have this distrustful attitude and 2) people keep proving me right by not being responsible or trustworthy???  I thought about titling this post "Crack Head DVMs" since I'm about to talk bad about so many of my colleagues but changed my mind because the scope is wider than just vets.

Naming no names, I want to share a series of mostly recent scenarios - facts have NOT been changed.  There really are some scary practicing DVMs out there and a lot of them are apparently in my town!! 

Case transferred to me from another hospital due to finances.  Very small toy breed having a seizure, we check a glucose which is 29 and give glucose and the seizure stops.  I look at the transfer record which states, checked glucose=39, administered valium.....

A relative's dog goes to the ER clinic for breathing difficulties.  Owner expresses concern that maybe the pollen is causing the problem.  Vet says no, dog has heart disease.  If pollen were causing problem, gums would be blue instead of pink like they are.....

Same dog, really does have heart disease with pulmonary edema, is treated with lasix (appropriate), IV fluids (WHAT?!?), and NO oxygen.....(and ends up with a bill of nearly $1300).....

Regular client of mine who is a very good client, also an MD but a good one not a pain, takes her Chih to the ER clinic for ADR (ain't doing right for those of you not in the know) and is told that there was no need to bring the dog, nothing to worry about.  They then reach me, I see a dog with cyanotic gums, significant dyspnea, tachycardia, and clearly distressed.  Chest films show pneumonia.....

Another vet tells an employee that it doesn't matter if you use a U-40 or U-100 insulin syringe, there's no difference.....

Another vet states that he doesn't understand why a rescue group is spending money on a sick dog, after all, it doesn't even belong to anyone.....

A cat with pyelonephritis fails to receive its antibiotics for 2-3 days while the primary vet on the case is off.  And the other vets and technicians didn't think this was important why?????

Patient hospitalized for resistant urinary infection is left off IV fluids for 24 hours while receiving Amikacin even though the orders clearly state must be on IV fluids.....

Patient orders are clearly written in multiple places and verbally communicated to the vet taking over the case for the weekend but are not carried out.....

Intern on ER takes in dog in fulminant right heart failure and attempts to start IV fluids only to be stopped by the student.  Refuses to listen until senior clinician is notified.  Reasoning behind fluids?  That's what you do for "emergency stuff".....

Cat patient of mine that was highly suspicious for asthma or HARD (heartworm associated respiratory disease) or Toxocara cati larval migration whose owners kept putting off diagnostics due to money wound up at the ER.  Chest films were taken and they were told completely normal, no evidence of above.  I requested a copy and there are the most lovely "railroad tracks" and "doughnut holes" you could picture.  In other words, a beautiful bronchiolar pattern suggestive of above listed differentials.....

Heart failure dog referenced earlier is told at discharge that dental disease was the cause of the mitral valve disease in a senior Yorki-Poo and that the teeth must be cleaned within a week (remember this dog was hospitalized for congestive heart failure).  I advised that if the owners felt compelled to follow this advice they could take her back to that clinic and let that doctor practice CPR since I'm quite comfortable with my skills.....

And the list could go on and on and on.....those are all (except two) from the past couple of weeks.  And everyone keeps asking why I'm in a bad mood and never trust others.  Heck, that's the main reason I pursued vet school.  While I care about my patients, the most important thing to me is that my kids get proper care and I couldn't find anyone I trusted for that!  Even now, if a specialist is needed I hand pick who we see.

Yes, it is also a job and a means of living but, I have to comment that if you chose this profession, regardless of the reason, you damn well ought to be doing the best job possible.  Not saying I've never made a mistake but I know my crap and if I don't I tell you so and go look it up.  I'm really sick and tired of shoddy, non-caring work not only from my colleagues but also from my employees, my mechanic, my personal doctor, my friend's doctor, students, etc,etc,etc!!!!  Not everyone gets to "live their dream," in fact very few of us do.  I'm far from where I truly WANT to be but you better believe that every day I give my work and my family and my home all that I have. 

And a last comment seemingly unrelated but I can't help but wonder if it played a role in the congestive heart failure dog receiving fluids.  While Pro-Sal sounds like it is the best financial option for vets, I'm not so sure if it causes certain vets to do things that are unnecessary in order to increase their production.  Of course I've also worked with some vets who do that anyway when production is not even involved in salary, just trying to increase the bottom line.  That relationship did not last long.

I guess I'm just wound up a bit over a couple of my usual beefs meaning justice / fairness and doing things right rather than just doing them.  My latest life plan is to run away to Antarctica because 1) I'd never get too hot, 2) I could go for months without having to talk to anyone, and 3) since nothing can grow nothing can possibly bloom.  And I wouldn't have to worry about any of this!