Cats

I've often been asked if I'm a "cat or dog person" but I always find that difficult to answer. I have both and enjoy both. Had horses prior to vet school but they died due to old age and I haven't had an appropriate opportunity since to get more. Really, I enjoy them all. If pressed, I would probably admit, however, that I have a tendency towards cats. Likely, it's my personality speaking since I would definitely be a cat if I were an animal...

Usually, I chunk all of my important junk in my purse at night and it sits on the counter often partially unzipped. I must remember to zip it completely or put it away where the cats cannot get it from now on.

Last night one of the cats raided and pilfered from my purse! She (I guess I should say allegedly since I can't really prove who the culprit is) stole both sets of keys, my watch, and a pen. I thought that was all and had recovered them this morning prior to going to work to check on my hospitalized patient. Only now did I discover differently. I got called about my patient and had to go back to get some anti-nausea medication for him only to discover no ID badge to get in to pharmacy. I frantically searched for several minutes before the truth dawned. Fortunately, one of my colleagues was there and loaned me their badge to get the drug. I came back to the apartment and demanded that the loot be handed over. Took me a little while to find the stash...there was another pen hiding too!

Cats! Gotta love 'em....

Sarcasm Rules the Day

Sometimes, my sarcastic sense of humor takes over and crushes the filter down with the end result being that I say things I probably shouldn't. The bad part about the big one today is that I'm now going to repeat it on this blog. Can't seem to help myself. It's probably a product of the fact that I've been very bored today and looking for ways to cause trouble. Planning some great pranks for tomorrow...

Hopefully, not everyone out there is as illiterate as most of the students that I've been working with lately and are at least somewhat familiar with the classic Dickens' novel A Christmas Carol. There are many movie versions of the book and one of my favorites is the old version starring Alastair Sim in which he dances and jumps on the bed and sings "I don't know anything..." at the end. Prior to his redemption, he makes the comment to someone who is soliciting donations for the poor that "they had best die, then, and thus decrease the surplus population."

That lengthy intro to explain what came out of my mouth completely unpremeditated today.

One of my intern-mates was telling me the story of a former classmate of his who was instrumental in changing the school policy to surgery only on cadavers. After graduation, he talked to the person from whom she obtained a job who reported to him that the girl was incapable of performing a routine spay or neuter because her ligatures were not secure and all the patients then began to bleed, she freaked out and had to scrub out of surgery leaving someone else to stop the hemorrhage. She now plans to open a low cost mobile spay / neuter clinic. He very kindly put it that she was "misguided." What do I say? "I guess she's doing her part to decrease the surplus population!"

It took him a minute to realize what I implied and then I had to explain the reference so that he didn't revise his opinion of me to think that I'm a total monster...

Yep, that horrible sense of humor is going to be the death of me one day!

Sometimes it's all in the delivery...

Ah, another grump. Really, all too often things that make one mad could be not a problem at all if the delivery were only different. Think about it - there are so many different ways to say things and you can make almost anything sound better or be less abrasive if you only take a moment to think about it before you say it and try. To quote a couple of old sayings, "My mother told me if I couldn't say anything nice not to say anything at all." and "You catch more flies with honey than vinegar."

That lovely intro to complain about negativity. Honestly, I don't mind receiving constructive criticism and bouncing around ideas on how to do my job better. I'm actually my own worst critic by far. The problem is that people come in and criticize without bothering to find out the whole story and without ever offering a word of praise or considering the situation.

Two stories to illustrate the point. One relates to me, the other to one of my intern mates.

My intern mate is currently on emergency overnights. One of the critical patients in ICU went into respiratory arrest early one morning because it developed a tension pneumothorax (known pneumothorax, had been stable and suddenly deteriorated). He treated the patient and kept it alive allowing it to be rushed to emergency surgery. (The patient, by the way, is doing great.) What do the surgeons do? Do they say anything like, "Hey, good job. We can talk about other things you could do, etc.?" or "Thanks for keeping the dog alive; we know you work under difficult circumstances..." (I'm sure most of you are laughing your heads off at the moment - so my sarcasm is blatantly obvious.) Of course not. Instead, they take the dog to surgery then when he comes back in for his next shift (did I mention he stayed late helping after a 16 hour shift by the way?) they pull him aside to point out all the things he had done wrong and how he could have "treated the case more aggressively."

For me, on my ER shift this weekend, I admitted a cat that escaped the owner's house sometime during the night and got mauled by a dog or coyote or something. On presentation, his temperature was so low it would not read and his veins were so constricted that they looked like a line drawn on paper. We could not gain IV access for quite some time and started warming him aggressively as well as "bolusing" warm SQ fluids. I finally got an IV catheter in him when his temperature reached 89. The owner didn't have a lot of funds so we threw that into therapy rather than diagnostics and managed to have an alive as well as much improved cat the following morning. With what was I greeted? Why didn't you get thoracic radiographs and full bloodwork? Well, first because it took so long to warm him that I didn't want to freeze him again in radiology, not to mention that I did not feel that he was stable enough to go to radiology. Also, the price limit given to me by the owner basically covered stabilization and one 24 hour period in ICU - what good is a thoracic radiograph if you then have to euthanize due to lack of funds? There was (of course) never a "good job on keeping the cat alive, now that he's more stable we should talk to the owner about further diagnostics." (Would have been that simple to make the statement inoffensive - after all, I know that the recommendation is to obtain thoracic radiographs on trauma patients, it's not like it was ignorance factor.)

I don't know; there's always room for improvement but it is just so discouraging when negativity is all that ever spews forth. They also never seem to consider that on ER shifts we are lucky to have one technician on with us;not like the gaggle that they have following them around during the day. Yes, there are students but they cannot be depended upon to have the level of experience needed for an extremely critical case - besides, they aren't technicians and can hardly be expected to have the technical skills needed.

While I'm complaining, I also get really tired of the negativity between technicians. In the ICU here, it seems that they have chosen sides as if in a feud. Monday morning, I'm bombarded by criticism of the tech on over the weekend for not putting in charges, etc. without ever a question of "how was the weekend" because, you never know, there might be a good reason that charges were not put in. In this case, it had to do with the cat previously mentioned that was followed by one of our critical cases (septic abdomen) arresting and receiving CPR for a prolonged period (we got him back twice but failed the third time), etc., etc.

The old adage about walking a mile in my shoes before criticizing is really true but so few people do it. I wish I could just make people pause just for a moment before opening their mouths and consider what they are about to say. If they would, I think they would often either rephrase or just not say it at all.

On Fridays, Being Thrown Under the Bus, and Other Odds and Ends

It is absolutely amazing, the difference in the hospital on a Friday evening in comparison to any other day. While most things move at the speed of molasses in the winter, on Friday, suddenly, it's as if a new life is infused. Let a back dog come in at 4 and it's guaranteed that the imaging, including CT scan, will be done by 5 and the dog will be well on its way to surgery. Any other time, the molasses would slowly move and it would take hours to be done.

The other amazing thing about Friday is how quickly everyone hits the door. Better not count on someone being there at all late 'cause it ain't happening. By 5:00:01 they are gone. WHOOSH!! The gust from their leaving could knock you down and you'd better get out of the way.

And, in the vetmed world, Friday is often "dump day." All the nearby rDVM's decide that they should unload the challenging cases in their hospital that they don't want to deal with over the weekend. I've never quite understood this since most of the time further work-up won't be possible until Monday anyway, even in the referral hospital. It's even worse when the dumping "rDVM" is the in university hospital community practice (CP) service. There were at least 2 cases sent home abruptly today that I doubt were really sent home for the well-being of the patient. No, I would distinctly say that it had to do with the convenience of the clinician... To explore the motives can sometimes be a frightening prospect (even your own motives at times).

Interestingly, I have only gotten one "dump case" tonight; or, to put it better, this one is what I sometimes refer to as a "prefergency." It is a not extremely critical patient that needs further diagnostics and it was "easier" to come tonight rather than wait until Monday. Guess they have the financial means to pay for the preference as well.

Yesterday, on the other hand, was an entirely different ballgame. Yesterday, though, was more of a "thrown under the bus" type of day. Sadly, not by outside sources but by people working side by side as colleagues. Not that the occurrence is abnormal in this place. It is actually quite commonplace and you feel more surprised when it fails to occur.

A snake bite case showed up at quarter til 5, the ER overnight shift starts at 5. Guess upon whom it was dumped. I think that the icing was when the CP clinician then tried to dump callbacks for their cases on us and later called to ask about the snake bite and criticize the planned treatment regimen. Out of last night was born the repeated quote (and very atypical attitude for me) of "Not my problem!" I guess there comes a point for all of us at which we are tired of lying down and saying here, why don't you wipe your poop covered shoes all over me as you walk across my prostrate form.

This particular rotation, or I guess I should just say the last few weeks, has been particularly bad. It's easy enough to deal with small problems but when they mount up to an enormous pile they become overwhelming and that is when tempers flare and patience becomes frayed. In fact, it is usually the pile of small things that make me break much faster than the big issues - those I just take in stride. And no matter what anyone says, it always seems that if a shift begins one way, it just can't seem to be turned around and made better!

So much for Fridays...When you hear the ka-thump, just look for the big yellow bus that ran me over then backed up for a second chance.

Money

I'm going to tackle a tough subject that comes up all too often, particularly these days with the current economic situation.

It's 2:16a.m., I receive a call that wakens me from my catnap stolen on the recliner in the faculty lounge. "We have a 6 week old puppy that got stepped on and has blood coming from its nose. What should we do?"

I ask the usual questions that I use primarily to get the owner to calm down a little and also to ascertain how bad of a situation we have. I advise the owner that the puppy should be seen then advise them of the emergency fee and payment policy. We are supposed to do this with every call unless they indicate the pet is actively dying and I have learned to do so anyway in order to save grief when clients arrive with no money.

"Do we have to pay it all now?"

How often do I get asked this question. "Yes, you do or if the pet stays in the hospital you would leave a deposit of half the high end of the estimate."

"Oh."

"Are you coming in?"

"I'll call you back."

Translation = No, not spending the money.

Why do people seem to believe that veterinarians should not charge for their services? "But I thought you loved animals!!!" Like any other professional, we deserve to be paid for the things that we do as well as the materials that we use. And how many other professions allow you not to pay up front? I've always wondered why people look at us differently in that aspect.

I should point out while I'm saying this that I tend to be one of the worst when it comes to letting things slide. I've been in trouble with my boss at every place that I have worked thus far for not charging for some things. I immensely dislike "nickle and diming" people. Really, you want me to charge for the 3 staples I used on that laceration separately? Yes, I know that realistically, it all adds up to a far larger sum than I realize but sometimes it just seems unfair.

One of the worst is when a very critical patient arrives and you still have to charge the ER fee just to euthanize. It's hard enough trying to get money from people when they have nothing much less from people whose pet you just killed.

And I know that one of the arguments is not to have pets if you haven't the money but I'm not sure that I consider that particularly fair either. I couldn't have pets right now if that were the rule 'cause I sure can't afford them. If I didn't have them, though, I would truly be pushed over the edge; they allow me to maintain what little sanity I have left.

Tonight, I got a call from a guy who has $100 total and his dog just did something to hurt its nose. Sounds like the dog will survive the night and I bluntly told him that he will be able to stretch that money farther by waiting until morning and seeing a local vet sans emergency fee. People have a hard time swallowing that information but I'm nothing if not honest. That then becomes difficult when people get angry saying you are refusing to see them and don't care about their pet. The bottom line is that in the situation I'm in currently, there's really nothing I can do about the financial policy and if I were to admit the pet to the hospital, they would just rack up a lot of cost which they cannot afford then get sent to collections. Unfortunately, they are usually too upset to see that I'm trying to make my best judgment call decision for their pet's welfare.

Sticky situations always seem to revolve around money. And they wonder why veterinarians seem to feel as if they don't deserve to get paid for their knowledge....

To Dr. May B. Insane

Don't you know? When people own dogs, common sense flies out the window! Kind of like the owner I see constantly who "breeds" blue heelers... he *never* brings his puppies in for taildock and dewclaw removal in the established 3-5 day old window as "ideal" for doing this procedure. Instead, he brings them in usually from 8-14 days old... the then require local anesthesia to do the procedure... even though I've told him fifteen million flippin' times to bring them in 3-5 days of age... People are STUPID!!!

Dear Stupid Client from the Insane One

I fail to comprehend people and have determined that common sense does not exist!

Last night at 8:30, I received a call from a client whose cat has a chylothorax and has chest tubes in place. They reported that the cat had been open mouth breathing although it was resting comfortably at the time of the call. They live 3+ hours away.

I advised the clients that they should ideally find a local ER clinic and have the cat evaluated immediately. The alternative plans I offered if a local ER clinic could not be found were as follows: If the cat remained stable, have him evaluated by the regular vet first thing in the morning or head in this direction.

I heard no more from them until 4:20a.m. at which time they called, in a panic and in tears, to report that the cat was "still" open mouth breathing and no one would see them without their being an established client.

Need I point out that they could have been here hours ago had they listened to my advice...