On Southern drawls, crazy clients, and my nasty sense of humor

As I've indicated in the past, I do have a nasty sense of humor at times. Just can't help myself when it happens; something sets me off and away I go completely unable to check myself. The title ties it all in together you see...

Last Friday, one of our crazies came in wanting to see me. Now this is a novelty as most folks come demanding to see "Doc," not me. Turns out she had seen Doc about 2 weeks prior with her dog that she had suddenly taken on a 2 mile hike after not exercising at all for 2 months then was concerned when he became lame. Hmmmm. Genius, figure that one out. Apparently the current unrest was due to the fact that Doc failed to x-ray the leg on that visit but indicated that if the dog failed to improve that would be the next step. Enter crazy client wanting to see the other doctor!

My exam showed the same things Doc had found but I went ahead and did x-rays since there was no ethical reason not to do so and it was what the client wanted. Surprise, surprise, there were no major findings on the films. I had a blast explaining all of this to the client who fits the stereotypical Yankee know-it-all type we ignorant Southerners dread. Since the client clearly knew everything, I started tossing out "doctor words" and using correct anatomical terminology just to make her squirm and have to ask what it meant. The crowning moment was when I said "stifle" and between my drawl and her confusion she thought I said "stafle."

That incident made me remember another time that my drawl caused confusion to a poor Yankee soul. I was instructing an owner in another state north of the Mason-Dixon line to cook boiled chicken and rice to feed their dog who had stomach issues. The owner asked me what that was. Admittedly, I was very confused wondering who on earth had failed to hear of boiled chicken and rice so I rather hesitantly replied, "You put chicken in water in a boiler and boil it on the stove and you do the same to the rice just adding no seasoning to either..." Perhaps all y'all that have heard my drawl or a similar one have already figured out the key but it took the owner explaining to me that they thought I had said "bald chicken."

Having a Southern drawl is certainly fun and I'm quite proud of it. I can also make it worse when I feel like it; particularly when my sense of humor gets out of control and I decide to really put on the ignorant Southern act in order to take someone out. At certain places that I have worked I really believe that people asked me questions simply to hear me speak. There were certainly times that I've been requested to say certain words like dog or walk. As I told one person I knew, though, at least we in the South know that "drawer" has an "-er" on the end unlike the person with whom I was conversing who said it "draw." Now it really gets funny when I take my Southern accent and imitate Brooklyn...

The problem is the heat, you understand. In the South it gets so hot and humid that we have to speak slowly and let our words kinda lean on one another for moral support or we'd never say anything at all!

Another incident of Friday was also very satisfying (I was really on the roll once I got started!) About 3 weeks ago, I pinned a femur fracture on a little dog then received a call from the owner who had seen another vet for the recheck on day 12 that it was not healing, the pin was placed wrong, and the leg needed to be plated immediately. Side note, there are definitely some of our colleagues that need to learn the art of client communication and how to respectfully disagree with your colleague rather than running them in the ground. The owner had a hard time getting the dog to us (long story) but e-mailed the films which did show no evidence of healing and the pin being apparently in the joint. I had the owner get the dog to us (no one there wanted to touch it since they had not started it) and leave it since travel was a problem, at no charge for the boarding. Rechecked the film and saw that the pin was fine - my colleague failed to get a perfect lateral view therefore the pin placement appeared questionable. Additionally, the leg is healing nicely. I think I shall e-mail those films to a certain veterinarian with a very nicely sarcastic comment on tangential x-ray beam artifact.....

Day late and a dollar short...

Oops...I meant to log in yesterday to wish my dear darling friend Can'tSpell a wonderful happy big 3-0 but I got sidetracked and didn't. So, here it is, a day late but sincere nonetheless--(drum roll please)

HAPPY BIRTHDAY!!!!!!!! YOU'RE GETTING SO OLD YOU MIGHT CATCH UP WITH ME!

Bad Dawg (and Cat)!

Spring in the South comes upon us early in the year and with it comes the inevitable allergy season. With temperatures soaring into the 60's and 70's over the past couple of weeks, everything is blooming and providing pollen along with all the other wonderful instigators of allergies. Like most children, 2 or 4 footed, mine take advantage of the times when mom is under the weather and therefore less than her usual vigilant self.

Yesterday, I was running a little late as is usual in my too booked life but thought that I would make it to work at maximum only 5 minutes late. That's what I thought...

I walked in to feed my herd of wild cats and was greeted by Pistol bailing off the counter into one of the water bowls. The bowl slid and hit the other water bowls sending water spraying everywhere and onto everyone within 6 feet. Predictably, he flew upward out of the water faster than he hit thereby further splashing water from the bowls and from his body. In the midst of this commotion, Katrina (aka the white witch), flew out the door and was loose. The poodle came to join the fun and started chasing Katrina who was so frightened she wouldn't move from the tiny little hole where she had hidden far out of reach. Anyone want to guess how late I was?????

The boys (the small 3 dogs in my herd) often go to work with me now since Rusty-dog is getting old and reverting to his severe separation anxiety from early in life at the time when I adopted him. For whatever reason, the boys screamed half of the afternoon while in their crate, complaining about being at work. If they had stayed home, it would likely have been worse.

When the craziness of the day was finally done, they were practically dragging me (and Rusty since he doesn't see or hear well and gets confused about where doors are) outside. My co-worker's car was parked closer so Buddy ran to it as the closest means of escape. I could hear the conversation in my mind:

Buddy: Let's go guys, here's a car, jump in!

Scout: Are you sure it's our car?

Buddy: Who cares?!? Let's blow this joint!

Scout: OK, man, who drives?

Buddy: It was my idea, I get to drive of course.

Scout: That's not fair...

Rusty: What are y'all talking about over there?

Buddy: No worries, Rusty, just jump in.

Rusty: But where's mom??

Buddy: Who cares, she'll make it home somehow!

Scout: That's not fair; I want to steer.

Buddy: Shut up you two and get in the car! I'll steer and y'all can operate the pedals.

Scout: Cool! I get the gas!!

Rusty: Pedals? I don't understand...you know I don't hear very well anymore...

Fortunately, they had leashes attached so I was able to prevent a carjacking. Would have made an interesting news story though.

The boys have also made further use of my fogginess to steal food, cat poop, etc., you know, anything they're not supposed to have that makes them sick and keeps me up all night further depriving mom of much needed sleep.

Now imagine fuzzy-headed, dizzy, allergy ridden mom who is more sleep deprived than usual going to work and attempting to answer some of the crazy client questions that arise on a daily basis. It's a scary thought, isn't it?

Thank you, Walt Disney et al

Have you ever stopped to think about all of the different venues that somehow contribute to our profession? Over the past few years, I have made a concerted effort to avoid the phrase "the back room" or any variation thereof.

Why?? Well, think about all the lovely movies that refer to taking the animal star to the "back room" where untold horrors will occur. Homeward Bound, Lady & the Tramp, Beethoven, just to name a few.

Yes, I love these movies and am an avid Disney fan but they do contribute to some of the negative emotions clients feel about veterinary medicine. Many times before I thought about this I would refer to taking a beloved pet "to the back," meaning of course the very plain, safe treatment area to protect both the pet and the owner while a benign procedure was performed, only to be greeted with a horrified look and extreme reluctance to relinquish said pet into my hands. It took me a little bit to connect the dots but since that time I've always imagined what horrifying images must be going through the poor owner's mind...

And so I say "Thank you" to the movie industry as a whole for adding more work for us.

Oops!

Had to share the funny. In a vet clinic when folks are restraining animals often unintentional inappropriate touch occurs. It's just a fact of the job. The tech, groomer, and assistant were behind me holding a very reluctant pooch trying to get the nails trimmed as the final touch of the groom when I hear the following exchange:

Groomer to Assistant: Okay, let go of the boob!

Tech to Assistant: Here, hold this one!

Note: The tech was referring to a dog leg which was what the assistant was trying to hold the entire time - we do not r0utinely practice boob holding.

Frustration

I'll have to give a little background here so the following makes some sense. For those who don't know me or haven't figured it out, I tend to be pretty OCD and paranoid about certain things - particularly the care of my personal kids and my patients. I also spent most of my life thinking I would hate teaching in any way, shape or form but was surprised to learn through firsthand experience that I actually enjoy it. I'm one of those weird folks who is extremely laid back and easygoing in general but have a very intense, type A, streak about certain things that seems to hit people by surprise when it arises...

All that to introduce comments on a couple of items. I get very frustrated and angry with myself when I make mistakes. If the mistake resulted in the loss of a patient or even could have possibly contributed to the loss, the anger is magnified many times. Yes, I know we are all human and no one is perfect but that isn't enough to stop my anger at myself.

I had a couple of critical patients come in on top of each other on the first day back after the snow when we were only open part of the day due to road conditions. One of those patients was a middle aged cat that was easily diagnosed as a kidney failure, apparently relatively uncomplicated. I've treated many of these guys, most successfully as long as there were no complicating factors such as owners unwillingness to try or underlying heart disease. This cat began to eat a little on the first day after just a few hours of fluid therapy so I was very encouraged.

The second day, the cat continued to look better and was eating small amounts; not ravenously but some. Around 3:30, I had her out again, re-examined her, and hung a new bag of fluids. At that time I also gave a small volume of hetastarch in addition to her crystalloids since her protein levels were going down with the fluid correction of her dehydration and the lack of significant intake. I was then busy for a time and the owner came to visit around 4:30. He asked the tech why the cat's face was swollen and they called me to look. Indeed, her face was swollen as was her tongue. It made no sense to me initially and I checked her lungs, etc. to see if I could find other signs of fluid overload but did not. I made some lame comment about protein levels being low being a cause of edema and that we would slow the rate in case she was trying to overload then the owner left.

I wound up stopping the fluids entirely and continued to monitor the cat. She was sleeping comfortably but would not eat anymore, likely because of the swelling. Around 2 a.m. I suddenly awoke from a sound sleep to remember that hetastarch can sometimes result in anaphylactic reactions. (Probably the astute reader already thought of that.) When I arrived at the clinic, she had died, apparently peacefully in her sleep since she was curled in her cat bed.

Since then I have agonized and beat up myself almost constantly wondering if she did have an anaphylactic reaction that I could have treated had I recognized it and was that the cause of her death???? Alternately, did she get fluid overloaded and should I have done something more??? I hate losing patients, especially when I know that I've done something wrong!!!

The other subject upon which I wanted to comment is our volunteers. Currently we have two volunteers. One is a recent high school graduate who has just begun taking the basic undergrad courses in preparation for applying to vet school. The other already has a degree and has decided to go back to school to become a technician. Unfortunately, my state no longer has a full time veterinary technician program and the only available program is done by correspondence with the practical portion done in private practice clinics who are willing and qualify to help train them.

The first volunteer is very nice although very young, if you know what I mean. (That's funny coming from me because I've always felt old compared to the people around me regardless of their age... In this case, she is very young!) She seems very interested, asks lots of questions, and is fun to teach; except that she talks too much when she is trying to ask something. I know, I'm probably being too witchy but it makes me crazy and I then have a hard time deciphering what she is saying because I get lost and tune out. I've often thought that one reason no one listens to me is that I pack too much information into too few sentences but I hate talking very much and try to give all the pertinent information as succinctly as possible when discussing a case. She was asking a question about her pigs and I got totally lost before she finished because she just kept going, much like the energizer bunny.

The second volunteer laughs too much and doesn't seem very dedicated. For someone to actually become a good technician through a primarily correspondence program, a lot of dedication and self-control is a necessity. I don't think this one will turn out well. I have no problem having a good time at work, enjoy a good joke, and can laugh about most anything but in a professional setting, there is a time and place for it. When I am euthanizing a long time patient in one exam room, cutting up and giggling just outside the door is highly inappropriate. This one just doesn't seem to care enough unless she wants to show off for someone. I'm getting the feeling that her primary interest is doing the "cool stuff" and that she really doesn't understand the job. The other difficulty is that she has been a client for several years and she has seen my "professional face" but not my "private face." This is very different because I'm very introverted in private but appear extroverted in professional settings.

Otherwise, things keep rolling along. I think this one is worth sharing as well for the comedy. There was a small dog that had a bladder stone that was removed by my boss the day before he left on vacation. I reluctantly sent her home on Saturday; she wasn't eating and just didn't seem to be bouncing back well but the owner was very insistent and I had nothing else to stop me. She presented again on Tuesday (first day back after snow) almost flat out, bradycardic, and with diarrhea seeping from her rear. Thought she had free fluid in the abdomen but wasn't positive until abdominocentesis found urine.

Yep, the bladder had dehisced and her abdominal cavity was filled with urine. In essence, she felt as if she were in kidney failure given the blood values (BUN >180, Phos=20, Potassium=8.5, Creat ??) but it was all due to the urine. I stabilized her with IV fluids then took her to surgery as soon as possible. Closed the bladder again and flushed the abdomen. The bladder wall was at least 1cm thick and very fragile.

Here's the comedy - I called the owner and was telling her the surgery went well but there was still danger that it could dehisce again, etc. given the state of the bladder. Explained that we may need to get her to a specialist if it happened again, that she couldn't live without a bladder and if the bladder would not heal we would be running out of good options, and that this could result in death.

The owner was slow on the uptake and responded "Do you mean we could lose her?"

Me: "Unfortunately, yes, we could."

Owner: "When will Doc be back?"

I almost laughed aloud. No, he did nothing wrong to cause the bladder to dehisce, it was a very unhealthy bladder. He is more optimistic and less cynical than I so it's very unlikely that he explained the dangers associated with the surgery. I'm sure that the owner figured I must not know what I was doing when I told her how bad it could be... Gotta love folks!

On College Football

I'm sure that anyone who has any interest in college football heard that Auburn won the championship in Arizona this time. For those of you who don't know much or anything about college football, particularly in the South dealing with the SEC and the Alabama vs Auburn rivalry, I am not going to try to explain and the following joke won't mean much to you. (I've tried explaining in the past and, unless you've seen it firsthand, I've found that you just can't grasp the extent of the insanity of football in the South.) For those of you who know, enjoy!

The Alabama folks have always said that hell would freeze over before Auburn won a championship title...

For once, it seems they are right.

Tuscaloosa was frozen.