Venting

I try very hard at my new job to foster positive client relationships. I try to be a good example to technicians by not badmouthing clients or ranting about stupid/uninformed people. It's very important for me to set a positive tone. It helps the techs work better, it makes for a happier work environment. It also makes me happier because I just let it go when people are asses or have a sense of entitlement or are just plain rude. On the other hand...GOD - some of them get under my skin no matter how good my attitude is. That's what the next 2 posts are. I needed to vent. ER medicine is a hard field - people bring in severely injured and sick animals, are under a great deal of stress, and often must cough up a large chunk of money in the middle of the night. I UNDERSTAND that. I empathize. I've been in the ER myself - notably when I had a kidney stone. I was screaming and vomiting. It's stressful and scary.

BUT I AM NOT THE ENEMY!

Diabetic what?

Dear transferred for overnight care from the local rDVM client:

Thank you for bringing in your Schnauzer-Terrier cross with diabetic ketoacidosis today. No, his muffin top is not normal, and no, McDonald's chicken is not a good diet despite the fact that it is grilled chicken and you squeeze the fat out of it before feeding it to your pet. You're very lucky he doesn't also have pancreatitis with his DKA.

Thank you for reminding me seventeen times during our lengthy discussion of DKA that your other dog died here 4.5 years ago, before I even worked here. And thank you so much for explaining that it's because he didn't receive his ultrasound.

I especially appreciate how you don't make eye contact with me or respond to me when I talk to you. I liked how this morning when I cordially greeted you to give you an update on your pet's condition that you kept your back turned on me and barely answered my questions. I also especially love how you accused me of leaving your pet lying in urine through the night (he was not, my tech took EXCELLENT nursing care of him and walked him very frequently, as we do with diabetics!) and also telling me that my tech reported vomiting, when in fact - there was NO vomiting, and my tech took great pains to tell me (and you) that very fact. Thank you for also accusing me of causing his blood glucose to swing by giving him too much sugar in his fluids. The wild fluctuations couldn't be because he has a SEVERE form of diabetes that can take days to weeks to regulate!

Oh, and no - you won't be visiting him MORE often than you did last night. Every 2 hours was plenty, and I was being flexible. Friday's nights are usually pretty busy times in the clinic. Oh, and I especially appreciate how you said that you don't know us, don't trust us, your other dog died here, and basically acted like I was the enemy when - in truth - I'm NOT out to kill your dog, I actually do like animals, and actually DO care if I do a good job.

Thanks!

Dr Please take your dog to a referral practice tonight!

Stay away from sharp objects

Dear I don't have the money to spay/neuter my pets but can afford an enormous escalade with 20 inch rims and pay for very colorful tattoos covering 80% of my body client:

Thank you for bringing in your actually very sweet SharPei this evening. It's possible he's so docile because he's in shock from blood loss. Keeping your 2 intact male dogs with your intact female dog is not a good idea, despite the fact that they've lived that way for a while. Yes, not spaying/neutering them can lead to aggression - especially when a female is in heat around 2 intact male dogs.

No, it will not cost less than $300 to repair the massive wound in your SharPei's head. Threatening me by saying that you're just going to put him down if it costs that much is not an effective way to get me to help you. I WILL help your pet by giving him some pain medications and bandaging his wound. It's very considerate that you don't want him to suffer while you make a decision.

On that note, no, you should not be able to see DOWN the ear canal by looking through the hole in the neck. Further, I should not be able to put 2 hands inside your SharPei's neck. Unfortunately, he is going to need many thousands of dollars of repair, as - given his breed - sutures will be a difficulty. Oh and yes, he is going to need multiple drains, as well as probably 2 days of bandage changes BEFORE we sew him up so that we can stabilize him and prevent him from developing sepsis and SIRS secondary to his massive trauma. And yes, you have to pay for that "up front."

Truthfully, thank you for letting me put him down - as I doubt he would have received the care he needed.

Have a great night,

Sincerely, Dr this could have been easily prevented with SPAYING AND NEUTERING or at least separating your male dogs from your bitch in heat

Aye, there's the rub

I've never watched Grey's Anatomy. I have no desire to, as I abhor TV in general, stupid medical dramas specifically. So, now they have Grey's Anatomy scrubs. It costs approximately $60 for a pair. Ridiculous, right?

The problem is - they are the softest scrubs I've ever touched, they're nipped in at the waist to be flattering, and they ride low on the hips. Basically, they're the perfect scrubs.

Thankfully, one of my techs is fabulous at removing the little tag that says "Grey's Anatomy" without damaging the scrubs. I'll be damned if I wear TV doctor scrubs to work.

Imagine if you will

A perfect day in the mountains of far west North Carolina. The sky is a hard, bright blue, the clouds like gigantic fluffy sheep with light grey underbellies. You're floating in a lake of green water, where you can see to the bottom at 10 feet deep. There are no noises other than the contented chatter of friends as they fish, drink beer, and generally revel in the delights of nature.

That was how I spent my Saturday and Sunday. We went camping with Jim's kayaking buddies at Lake Santeelah. It's a stunning, secluded, enormous lake/river system in Western NC. No pollution - natural or manmade. Just absolutely clear, cold, beautiful water. Our campsite was only accessible via canoe. It was about 1.5 miles of canoeing from the place where we left the cars. At night, all you could hear was the sound of crickets and frogs.

It was a very restful trip.

Now, I'm back. The painting in the house is finished (at least, in the living room/kitchen/library/breakfast nook/great room). All of the boxes are unpacked. The house is mostly ready for guests. I still have to paint the study, spare bathroom, and guest bed, but that will have to wait until my next couple of days off. We're having a lot of company in the months of September and October. I'm looking forward to it immensely.

It's back to work tonight for me, folks.

Checkout line confessions

As I was checking out at the grocery today, my husband was making polite chitchat with the female bagger. Older, heavyset, she had the air of a crazy cat lady. When she saw the litter we were purchasing, the conversation took a turn for the slightly maddening:

"So, how many cats do you have?"
My husband, "Six."
"Me too! Well, 7, if you count the outdoor cat. My newest one, she needs to be spayed. She's about to have babies."
Husband: mumbles something politely.
Her: "I can't afford to get her spayed. It costs too much. There's some sort of low cost spay around, but they make you get some shots before they'll do it."
Husband: nodding along.
Her: "I think they should do the spays for free! They're too expensive."

What do you suppose I said in response, dear readers?

Absolutely nothing.

Exotics extravaganza (cockatoos, bunnies, reptiles oh my!)

My first weekend was a good one, but it was thoroughly exhausting. I had a surgery both nights - a c-section on the first one, an enucleation on the second. Both went well, although I was surprisingly nervous. Perhaps because it's been a while since I wielded a scalpel.

At any rate, Sunday morning, I had all my cases wrapped up, transferred to the day ER doc, and was ready to head home. An owner calls and asks if we will see his bird. Neither of the other ER docs are comfortable with birds, so that left me. I asked the technician to tell the owners to go to the nearby specialty clinic. As it turns out, however - all of the avian/exotics docs are currently out of town at the AAV (Annual Association of Avian Vets). No one else in the area was open to see the sick birdie.

I sighed and told them to come on in. I can't resist a bird in need of medical attention. Especially when there is no one else to see it.

It was an interesting case, as it turns out - a cockatoo with neurological disease. He wasn't able to grip with his feet, he kept falling, and occasionally, he was maybe having seizures. After looking him over, I explained to the anxious owners that my primary differentials were heavy metal toxicity (lead, zinc poisoning) and proventricular dilatation disease.

Birds that free roam in houses (as my patient did) often eat things they shouldn't, chew paint, chew blinds, chew windowsills - you get the picture. Any time a bird comes in with neurological signs, ingestion of a metallic object has to be high on the list of possible causes. Yet, I've never actually had one that I xrayed have actual metal in the body.

This was to be my first. Imagine my delight when I saw a small metal foreign body in the proventriculus and proventricular dilation (a common sequelae to heavy metal toxicity). Thrilled, I began treatment with calcium EDTA (to chelate the metal). My patient did very well, was able to perch and grip, before transferring away to his veterinarian on Monday.

The downside? It took me until 1:30pm Sunday to finish working him up, treating him, and getting him settled. Thus, I had exactly 4.5 hours before I had to be back for the Sunday night shift. I wound up sleeping at work. So, on my first weekend, I was there for almost 40 hours straight. Plus, we had a doctor meeting on Monday morning, after my shift ended. So I was pretty much awake from 5:30pm Saturday through 1:30pm Monday afternoon, with the exception of a 3ish hour nap on Sunday.

Don't worry, it won't become a habit. It was worth it, to fix my cockatoo patient. I also had a bunny patient (with a head tilt) that was very fun (and rewarding) to treat.

I love my new job, by the way. The people are great, the place is well-run, and I'm in charge. Maybe that's my favorite part.

Smashing pumpkins

Tonight, tonight, tooooooonight...is my first night as a solo ER doctor (well, that's not true). Really, it's just my first night solo at my new workplace. I'm actually excited about going to work. Does that make me a sad person? I love what I do.

I'm working the next 3 nights in a row, then I have off 9 days. It's a weird schedule, but I like it - especially all the time off. It's a good thing, I have many house projects.

Alrighty, back to whatever I was doing. I'll keep ya'll posted.

Here there be dragons

When I was on my ambulatory rotation in veterinary school, we'd load up the big white trucks every day and go out to visit the rural folk of Tennessee. We'd treat cows, horses, sheep, goats, pigs, and basically any other livestock floating around out in the countryside.

One particularly gloomy, wet day, we got a call to an extremely rural area, probably a good hour's drive from the vet school.

Upon arrival, we were confronted with a large, nice house on a hill - in the middle of nowhere. Deep in the valley behind it was an oddly shaped, extremely large pasture with a barn situated on the hill overlooking it. Surrounding this pasture were very deep, very dark woods. It was raining, dreary, and overcast. No living person was to be seen. The nearest other soul was probably a good 6-7 miles away. We were in the middle of nowhere. It was very Texas Chainsaw Massacre.

We drove the truck down to the pasture gate and piled out of the truck. No people to be seen, but two horses (presumably the two we were there to vaccinate) were standing in the middle of this sunken field, grazing.

As we waded through the knee high pasture grass, we all heard it simultaneously. A low, deep growl that grew into a booming roar echoed through the woods. We froze. This was no dog bark, no warning growl. This was the roar of some very large predator. We all looked around incredulously but saw nothing.

Nervous, and growing ever increasingly so, as the sky darkened and fat raindrops began to fall, we continued our trek toward the horses. Lightning cracked, as we led the horses to the makeshift shed/barn.

As we were leading the horses, the roaring came again - this time twice. Now we were all scared. We made it to the barn and started setting up. At that point, a white truck rounded the crest of the hill and started toward the barn. A normal looking woman in overalls and boots climbed out of her truck and trotted toward us.

"Wow, great, you already got-" and here, the roaring again, "started."

At this point, we were convinced that some horrible monster was going to come charging out the woods and make a meal of us all. The owner noticed our jumpiness, smiled at us, and said, "don't worry, that's just the lion sanctuary down the road. When the wind is right, you can hear them at feeding time."

Busy busy busy

Working, cleaning, buying furniture, the busy-ness here never stops.

I think I'm really going to like my new job, especially the people. My first 3 nights were relatively low key. Most of it was shadowing, although I took a few cases myself.

Otherwise, I've been putzing around doing stuff to get our house in order. We've decided to make our dining room a library/reading room. I've always thought having a dining room and another eating room was kinda silly. Also, it necessitates having 2 eating tables, and I only want to pay for one. At any rate, we're having a painter do the great room of the house, since the ceilings are very high. Also, we just HATE painting. We can't put up the bookshelves and unpack until the painting is done, so I'm at kind of a standstill with house stuff momentarily.

We have a gas grill with its own line, which I'm happy about. We'll probably be grilling every single night for the rest of the summer. Of course, we need patio furniture...

Yup, that pretty much sums up my life right now. The hunt for furniture. When I have interesting veterinarian stuff to relay, I'll post again.