i've started (slowly) reposting the last 4 years of my blog. it will take a substantial amount of time, and i will be doing this work slowly...so bear with me. hope it's worth the effort. i might mention that my old posts (circa vet school years 1 and 2) are really whiny - and i find myself rather unlikable. i hope that will not be the case for my readers...
i served as both the internal medicine intern and the soft tissue surgery intern today. it was busy, to say the least. surgery had 9 appointments in the morning with 3 surgeries in the afternoon. on top of that, i was directly responsible for 2 fairly complicated cases - a cat in heart failure with pleural effusion and a dog 8 days out from severe thoracic trauma and surgery. it kept me hopping. my attending clinician suggested roller skates.
still, it was a good day. no - it was a great day. i felt like a real doctor, which makes me happy. all was well until i pissed off one of my internmates immediately before leaving. ah well...
sunday BUSY sunday... instead of 2 interns and an attending, it was just myself and an attending. she manned the "back" - i.e. the ICU patients and all the tech to the front calls (SERIOUS, immediate emergencies). i ran triage (all 6 of the exam rooms). it was butt-kickingly busy. this week was different though. instead of working a sunday after having worked ALL week prior, sunday was only my second day on in a row. and what a difference it made! i felt so much better. sure, it was busy. sure, i was rushed and stressed...but at the end of the day, i had some juice left. i had some emotional reserve left. it made SUCH a difference.
a smattering of the cases i saw:
1) 7 year old dog with DKA (diabetic ketoacidosis) -this is the extreme end of the diabetic scale and is a life-threatening and often fatal condition.
2) a very small (2lb) puppy with a very interesting fracture of the distal humerus (upper "arm") - for veterinary people - it was a salter harris type IV of the lateral epicondyle.
3) a 3 year old dog with a torn cranial cruciate ligament
4) a cat that was hung in a tree by its front paw leading to severe ligament and tendon trauma and a hyperextended wrist
5) an emergency "hotspot" i.e. a wet, moist place on the face likely secondary to a flea allergy
6) a little dachshund with vestibular disease - not sure if it was caused by an ear infection or a brain tumor - but this little guy could only make tight little circles, his head tilted to the left, and he would roll like a crocodile occasionally. otherwise, he was sweet and happy.
7) a large (90lb) airedale terrier with excruciating neck pain - the owner couldn't afford referral to the nearest institute for CT scan and MRI - i suspect a slow partial intervertebral disc herniation, wobbler's, or meningitis. since she can't afford referral, i'm treating for all 3 and crossing my fingers!
8) a kitty cat with a PDA (patent ductus arteriosus - very RARE in cats!) - this is a congenital abnormality in which the connection between the aorta and the pulmonary vessel DOESN'T snap closed after birth. it stays open, allowing blood to go in directions it should not.
those are only a few.
today was crazy at work. i had 2 fascinating cases under my care (a cat with pleural effusion and - as it turned out - heart failure and a post-thoracic surgery case) as well as some more routine but nonetheless challenging cases to manage.
i've flown quite a bit in the past few years - and every time i fly, my anxiety diminishes some. i still get mildly sweaty palms and a rapid pulse on take-off and landing, but overall - i can ALMOST sleep on a plane. all this flying has also taught me a great deal about when i can reasonably get to the airport and have enough time to check in, get through security, and board. like any decent american, i am impatient and despise waiting. i planned my trip to the orlando-sanford international airport carefully yesterday, arriving with a mere hour to spare before take-off. i was quite pleased with myself until the screen behind the counter flashed from my take-off time to one 2 hours later. ACK!!!
i sat in the airport for 3.5 hours yesterday. it was great times. we landed 2.5 hours late. i still had to drive 2 hours home from the airport. i suppose it goes without saying that i wasn't in the best mood ever when i finally arrived home.
and now i'm at work. we have 2 patients in the hospital.
sorry for the previous unapologetically pathetic post- brought to you by the last non-selective serotonin reuptake inhibitor dependent person in north america. maybe i should just join the masses of the over-medicated and start popping paxil or zoloft or lexapro...
before i left to come here, i had 2 cases that were eh...nightmares, shall we say? one was a cute big terrier (40lbs). he was a skye blue terrier or some other breed that we only see rarely. he presented in status epilepticus. SE is an extension of epilepsy. it occurs when a seizure does not terminate on its own - usually if a seizure lasts beyond 1 minute or so, it is termed status epilepticus. treatment is aimed at trying to "reset" the seizure focus by a variety of methods. one such method includes inducing a coma with a medication called propofol (often used to induce anesthesia in humans - known as "mother's milk" due to its white color). despite this, we could not get the seizuring under control. every time we attempted to wake this little guy from his drug-induced sleep, he would begin to seizure within the hour.
in the cage next to this unlucky soul was an ancient pomeranian - 13years old. he had a condition called collapsing trachea. it's a poorly understood disease of small breed, fat, older dogs in which the trachea (windpipe) collapses when they become excited. for some reason, the cartilage holding the trachea open becomes weak, allowing the airway to collapse under stress. this - as you can imagine - can be a very bad thing. this little guy's collapsing trachea was so bad that he was put on a ventilator by my intern-mate. i wasn't sure WHY she'd opted to put this dog on a ventilator, as his prognosis was very, very poor. he needed surgery - assuming that he lived and recovered to have surgery.
in the end, both of these were euthanized.
despite these sad endings, they were excellent (though challenging and a tad frightening) learning cases. i had never cared for a ventilator patient myself, and so i was very nervous and uber-conscious of checking everything i was supposed to be checking. despite the poor outcome, i learned a great deal.
i'm headed home shortly. my flight leaves orlando-sanford international at 5:15. i have to drop off the car at alamo and get through security, so i'll be leaving shortly.
i must say, my grandfather is fairly progressive as far as movie-viewing taste goes.
i was lying around being useless tuesday night (reading my book), and he was flipping channels. he couldn't find anything to watch, but stigmata (1997 - patricia arquette, gabriel byrne) was on. it's not a perfect movie - but there are many excellent qualities about it - musical score, cinematography, the theme...(also, staring at the absolutely luscious in a professorial way gabriel byrne is fabulous - at least for me), and i really love it. i actually own it on DVD. at any rate, it wasn't anything i thought he'd like - too racy. he loved it, to my surprise. he stayed up and watched the whole thing.
then tonight, he wanted me to suggest a movie. our on demand choices were very minimal, but the dark knight was one of the features. i can't say enough about it. i really do think it's one of the best movies (all of the independent/subtitled/french/spanish/etc movies i've seen INCLUDED) i've ever seen. it has depth, excitement, plot, character development, and despite being an "action" flick - it has a strong message.
he watched the whole thing from start to finish. all 2.5 hours of it. i think it might have been a tad too depressing for him, but he seemed to enjoy it.
tonight was lovely. i went out to dinner with my 2 closest friends - ones i made way back during my 2nd year of undergraduate (10 years of friendship and counting). tomorrow, my aunt is taking me to the yacht club for lunch - which will be decadent.
friday, i fly home. i'm happy to go. not because i don't like being here, but because i really miss my husband - first and foremost. i also miss my animals, my house, and my comfortable place. i think, as i grow older, i get more and more agoraphobic. it's a weird feeling.
i've also been deeply, deeply depressed for the past week or more. due to the nature of some of this depression, i can't really elaborate in a public forum. suffice to say that it has been a terrible melancholy that i can't shake. it's starting to affect me physically. i've had GI problems. every time i eat, i get sick. i'll spare the details. some of the depression i can talk about and is due to a sudden flare of pain related to the drowning of my cousin 3 years ago this past december. it's something i've mostly come to terms with, although lately - i've had a very hard time dealing with it, and i have been prone to sudden bouts of nausea and tears. maybe because of all the new, small children in my life (my niece, my nephew, and my friends here in florida just had their first child).
there are other emotions mixed in - like oil in water. feelings of self-loathing and a deep, deep sorrow for things that i cannot undo.
ah. how did i go from talking about watching movies with my papa to my feelings of utter abject misery?
i'll stop now and retire for the evening. this post will probably get taken down at some point.
wow. conferences are not relaxing. there's nothing relaxing about driving back and forth to orlando (45 minutes one way) daily, sitting in lectures for 7-9 hours, and roaming the exhibit hall with an overstuffed bag weighing me down in the meantime.
so - what have i done?
today was my cytology lab. it was 8:30am-5pm. if you're me, you've suddenly developed an inability to do ANYTHING right, as far as planning is concerned. i thought the lab was at 8am. didn't realize it wasn't until i was almost to orlando. then i realized it wasn't at the world center marriot (to which i had google map instructions) but at the nearby (i hoped) caribe royale. thankfully, i had inadvertently given myself an extra half hour to figure this out. finally, i made it to the lab only to realize that i'd left my ever so important, can't have lunch without it, get stoned if i even TRY to get into the lab without it ID tag. it was hanging in my car, back at the gaylord palms hotel.
other than today's poorly planned expedition, i have attended several excellent lectures - especially those by dr lee - a criticalist, seen some interesting new technology in the exhibit hall, picked up some good swag, and gone out to dinner with 2 classmates (now engaged to one another).
let's do some FUN math, shall we?
registration for the event (intern/resident fee) $140 cytology wetlab $450 (yes, i said FOUR HUNDRED FIFTY DOLLARS) airfare $100 *god bless allegiant air!* car rental $280 parking at the gaylord palms/day $12 toll road (to orlando and back) $4.50 lunch daily $15 (thankfully comped by the conference)
Grand total (out of pocket): Approx $1010 Work pays? $1000
Swag I acquired: 1) New Muir anesthesia handbook (Value approx $80-100) 2) 1GB knock-off Ipod shuffle (Value ??) 3) Basic veterinary procedures book (Value approx $35) 4) Other assorted goodies to include some LaFeber Nutriberries for the birdies (Value approx $50)
In the end, I think I win.
Someone remind me to tell you about my 2 side-by-side nightmare cases that I euthanized the day before coming to Florida. they were fascinating - though ultimately unrewarding - cases.
i'm awake at 6:30am. considering that i don't have to be at work till 8am, that's nothing short of miraculous. i have my completely screwed up sleeping schedule to thank for this. after working all night sunday/monday, i came home and passed out at around 10am monday morning. i slept until past midnight, which was not in the plan. i then staggered around in a fog for about 4 hours before retiring back to bed.
yesterday wasn't much better. i got up at 10:45, puttered around the house, then took a nap around 2:45 that lasted until well past 6. i spent about 4 hours being semi-coherent, then went back to bed. that resulted in me being awake around 5:30 this morning.
i really do wish i was a morning person. i really enjoyed making myself french toast and egg and biscuits today. i like not rushing around to get ready. it's nice to be able to sit down, eat breakfast, read the news, take a leisurely shower, pluck my eyebrows...etc.
but i'm not a morning person, and i never shall be. i love to sleep far too much.
i'm on 8am-8pm today and tomorrow. friday, my plane leaves at 7:30pm, so i should have time to get the stuff i was supposed to do yesterday (oil change, roots dyed, eyebrows plucked, verizon fixed) done before i have to leave for florida.
and i feel ... oddly enough ... so much better. the last 2 nights have been a vast improvement. i only did 1 euthanasia in 2 nights. it was a toughie, but it was a good decision. overall, i feel light and easy. perhaps because i'm so punch drunk tired from staying up all night (again) that i don't know the difference.
happy case story:
jett was a 2 year old, neutered orange tabby that came in because his owners said he had an oozing hole above his eye. on physical exam, he was dehydrated, depressed, feverish, and had strawberry-colored pus oozing from a hole on his eyelid. touching the area (WITH GLOVES) elicited a massive amount of pus. i explained to the owners that jett had likely been bitten by another cat and that we'd need to sedate him, clip the area, and clean out the abscess. little did i realize what this would really entail.
we sedated jett and shaved the area. to my horror (and a little bit of delight), using the clippers made the strawberry milk pus come cascading out. i was stunned to realize that this little "cat bite abscess" was the size of a half dollar - stretching from just above the eyelid to the base of the ear and down to the jaw. the whole area was black and dead.
i took a scalpel and some scissors and removed that area - leaving a gaping hole in the head. i was quite disconcerted. in the case of necrotic (dead) tissue, suturing the hole shut is not an option. this bad boy had one of 2 ways to heal - delayed primary closure (waiting a few days to allow the skin to form a nice little healing area - called a granulation bed) before attempting to close it or second intention healing (leaving the wound alone to granulate in and close itself). unfortunately, this wound would likely not benefit from the formerdue to the gigantic-ness of the hole and the absolute lack of extra skin on the head. a graft might have done it eventually - but likely it would just have to heal in its own sweet time.
i cleaned it, stared at it, sighed (it looked worse than when i started, obviously), and bandaged it. of course - 5 seconds after recovering from sedation - he had ripped his bandage off. we re-bandaged (hard spot to bandage on a cat!) and placed an e-collar. this time, he made it to the parking lot before pulling the bandage off in the owner's car. the third bandage (sort of) did the trick.
yesterday, i spoke to the referring veterinarian - and jett is doing great. the wound is granulating in on its own and is healing beautifully.
and all i can think about is the mcdonald's large sweet tea that will shortly be in my grubby little hands. i might forego the straw and just hook it up to myself IV style. i didn't sleep tonight/last night/this night(? it all starts to blur on overnights/ER). i had patients to take care of that i didn't wrap up until close till 4:30am, and now...what's the point? i'm "off" in 2 hours. i say "off" because i likely won't get home till 9am at the earliest.
i feel better tonight. better being the operative word. not great. last night, i thought of some ways to improve my end of things at the job. i implemented those today, and i feel like it made a great deal of difference.
see, it's not just the difficulty of dealing with irate and confrontational owners with no finances or putting down the 6th animal of the night for financial reasons or being told what a terrible, heartless person i must be to withhold treatment...it's also the fact that i've been having ... shall we say ... staff problems (?) lately.
this blog is anonymous, but i feel that i should be vague in exactly what this means. i also should try to maintain some modicum of professionalism. suffice to say that things are going on which have made me seriously question whether i will stay here next year or not. i suppose i will talk about these problems at some point. not now.
here's a post from a blog i read (ah, medical residency). it sums up some of what i feel about my job and why it can be such a weight. obviously - it's about human medicine and the experience is different - but some of the general ideas are the same:
"But mostly I’m just tired of the reality. Being confronted with society’s ills, in every sense of the word (because it turns out this job encompasses the literal medical ills, the economic ills, the social ills, etc., which is a lot more than what they advertise in medical school), on a daily and nightly basis is like (warning: over-used cliché alarm) being forced to push an immeasurably heavy stone up an unbelievably steep hill…only that the stone keeps getting heavier and the hill keeps getting steeper on a daily (or even hourly) basis."
and with that, i bid you good night. or good morning. or whatever.
at the risk of my readers thinking i am terrible person and veterinarian, i am going to post the following anyway. this is the very definition of compassion fatigue. a caveat: i am not a horrible person, and i would never deliberately hurt an animal. the day i do is the day i quit being a vet.
last night, i felt like there was a hole in my soul. all week, there have been 2 themes: no money and euthanasia. granted, i work in emergency medicine. some weeks aren't like that, though. some weeks - in a whole 7 day span, i'll do 5 euthanasias or so. on thursday night, i did 4 in a row. i examined and sent home animals with major medical problems because the owners had no financial resources and didn't qualify for care credit.
last night, i was angry and my temper was short. i felt terrible. i actually felt angry toward animals - which has never happened to me before. normally, i just feel bad for them - even the biters, scratchers, growlers, and thrashers. after all, they're animals - it's not their fault. i don't tolerate rough handling or saying bad things about patients. it's not acceptable - ever. last night, i almost lost my temper with a terrified patient. i made myself stop handling the dog, take deep breaths, and had a technician take over, while i stepped outside to compose my shaking, barely holding it together self.
i also had a couple who brought in a cat that was mauled by a dog. there were 2 crush wounds on either side of the body - one penetrating the abdomen, one penetrating the thorax. a hernia or massive hematoma was visible on the side with the abdominal hernia. the cat needed shock stabilization and emergency exploratory surgery. the owners didn't really have the funds of $1500 to spend on this cat, although they wanted to and could have done it, had i pushed them. but they really wanted to take the cat home and at least "give it a chance." i explained to them that the cat would likely suffer a slow, horrible death if they opted to do that. i dealt with them as compassionately as i could, but i'll be honest - in my head, all i could think was "hurry up and make the damned decision to put this cat down!"
that's a terrible feeling to have. as i euthanized the cat, i didn't feel a drop of sadness. i just felt empty. even when the owner gathered the cat in his arms and sobbed. normally that - at the very least - prompts a few tears.
i asked my boss/senior clinician (after the evening rush was over around 1am) if i could go home and recuperate before the weekend. on saturdays and sundays, i don't have to be in for the night shift until 8pm. so i came home and attempted to relax.
this morning, i woke up at 8:15am after dreaming all night of dying animals and sobbing owners.
all i can say at this point is THANK GOD that i'm going to NAVC (north atlantic veterinary conference) in orlando in 1 week and will have a whole 7 days away from my job.
i thought i was handling the absolutely horrifying run of owners with no money and no resources and dying animals as well as possible. that is - until i got to work and saw a note in the computer. the chihuahua i saw on tuesday with the open soft spots died at home yesterday.
was it my fault? no. the dog had a serious medical condition that needed surgical treatment or euthanasia. the owners opted for neither.
so, i'm a liar. i said something once about how i would post about bright, shiny, happy things. that was a bald-faced (or bold-faced) lie. LIE. L-I-E.
i euthanized the first 3 patients i saw last night.
patient number 1: poor kitty came to me twitching and staggering. kitty could not stand. the third eyelids were up, but kitty was still making biscuits and purring. in the span of 30 minutes, the vomiting began. the bloodwork showed hyperglycemia, hyperkalemia, elevated BUN, and a low pH (acidosis). the antifreeze test was screamingly positive.
patient number 2: one of 2 pitbulls in a fight in the owner's garage. torn up but very salvegeable. needed xrays and stitches. the owners were concerned about future aggression toward the other dog (although the new puppy instigated it), as well as their 2 month child (a legitimate concern). they requested euthanasia. the male owner held the dog after he passed and sobbed into the bloodied fur.
patient number 3: an outdoor cat that presented cachexic, laterally recumbent, with pupils of unequal size. since she was outdoor - anything was possible. trauma, toxin...owners requested euthanasia.
and i didn't give away a single treatment last night. i didn't knock anything off my charges.
as someone so astutely pointed out: if you're a nice person, the mechanic still expects for you to pay for the new transmission - it doesn't matter how badly you need the car to get to your job and support your children.
lest i be accused of being heartless - i do NOT equate beloved family pets with the dodge neon in the driveway. the parallel is still there.
that was a comment written in response to my last post, and i'm curious as to what the writer meant?
if she meant that i will be punished for actually charging for the services that i render and expecting payment, then i am - frankly - stunned.
it goes without saying (if you read my blog) that i work my butt off, that i care about my patients and what happens to them 100%, that i stay up nights worrying about what i could have done better as a doctor, what i missed, what i neglected to do. and i don't do this out of concern for liability. i do this because i want to be the best vet i can be. i strive to achieve that ideal EVERY SINGLE DAY - no matter how tired, how stressed, how sick i am. i don't let myself off the hook for one moment.
and in a mere 6 months, i have discovered that people are dishonest or uninformed and that my judgment of character is often wildly, wildly wrong. thus, it is impossible to form an objective standard by which to judge people.
examples: a man and his young son brought me their beautiful 2 year old cat. money was tight, and the cat was extremely ill. in 2 days, he went from sporadic vomiting to throwing up every time you touched him. i finally made the decision to go to surgery with him, although the owner didn't have the money. he thanked me profusely -telling me that he couldn't go home and tell his son that he didn't exhaust every option. he assured me he would make payments. i looked at the man and his son, and i trusted them. i went to surgery, the cat died afterwards likely due to cancer. that was FOUR months ago. the man has not made a single payment on the $830 bill. not even a $5 payment - despite numerous phone calls and bills.
another example would be the couple who wanted to give their dog with possible hemangiosarcoma a chance at 6 months of life (read the post a couple down on this page). after talking to them at great length, they decided they wanted the dog to have that chance - the chance that there wouldn't be gross metastasis, that i could take the tumor out and give the dog 6 months. we were on the same page before surgery, and i was confident. these people really seemed to trust my judgment and like me. they were 100% on board. aftewards, when the dog was euthanized due to metastatic cancer, they didn't want to pay the bill because they thought i just should have known that the cancer had already spread.
those are but 2 examples where my judgment of people has been terribly wrong. i could give you dozens more, and most long time vets could give you hundreds.
since there is no objective standard by which to judge people, their financial situations, or their honesty - then i have to assume all are alike.
it sucks, and it may sound heartless - but i am a veterinarian. i work in a business that profits from me, and i have to make money to support that business. do i hate turning away those with sick animals that cannot afford proper treatment? of course. but at least i can offer them humane euthanasia to stop suffering. sometimes that is all that i have to offer them.
last night at work was terrible. i saw 3 animals with life-threatening conditions. none of the owners had money. one was a tiny (1 lb) chihuahua with 2 open fontanelles (soft spots in the skull) through which the brain was trying to push. he also had terrible hydrocephalus ("water in the brain" - which really means dilated ventricles filled with cerebrospinal fluid) which was causing him to have neurologic disease. the puppy needed to be hospitalized and treated overnight with the plan to take him to surgery.that would have cost $800-1000 (surgery an additional $3000 at a referral institution). the young couple that owned him had $103 with them. i offered euthanasia. they declined. the dog went home with steroids. did it suck? hell yes. would i have preferred to keep that dog in the hospital and knock the bill down quite a bit? hell yes. could i pay my technicians, the overhead cost of our 20,000 square foot modern facility with digital xrays, ultrasound, and soon a CT scanner if that was what i had done? no.
and that was only one of the 3 cases with no finances that i saw last night.
it's not an ideal world. it's a harsh and unfair world. but unfortunately - we have to live in it. i do my best every day, and i try to help people whenever i can - at work and outside of work. and if what goes around truly comes around ... well then, i feel like i can rest easy at night.
last night a little wrinkled old man showed up at the clinic clutching a small (but fat) dog in his arms. the note from his regular vet said that the dog was anemic. how anemic? her PCV was 8. she had water for blood. all of the signs pointed toward immune-mediated hemolytic anemia, a disease i have discussed before. the typical cost of an IMHA diagnosis and treatment is $2000-2500. the patients require extensive testing, blood typing, crossmatching, and transfusions. even a "discount" IMHA (no testing, treat presumptively based on blood smear and some other cheap tests) is going to run $1000-1500.
this little man lives on a fixed income of $847 per month. he has no other money. he is little and would fit in my pocket. he reeks of friendly alcohol, cigarettes, and wears a fedora. he tells me that this little dog is his best friend in the world and tears up at the thought that she might die.
we spend a great deal of time discussing how dire her condition is. she requires a blood transfusion, which costs $250. she requires immunosuppressive drugs like prednisone and aziathioprine. she also needs aspirin and famotidine and doxycycline.
my soft-hearted technician volunteers to bring in her own dog and do a discounted transfusion for $100. while i hesitated (if we extend the discount to one - why not to all?), in the end - that is the course we pursued. the owner went to walgreens and spent $40 on the needed prescriptions (versus well over $100 at our clinic).
little dog gets her transfusion, as well as her medications and one night of ICU for the bargain of $500. after her transfusion, her PCV jumped from 8 to 22%. she perked up, her gums turned pink, and she ate a whole can of food with gusto.
i came to work tonight, and she was doing better. she had eaten all day, and she was pinker. unfortunately, with fluids - her PCV had dropped to around 13. that drop was likely due to her ongoing IMHA (it takes a minimum of 48 hours for the drugs to start working and sometimes longer) and the fact that she was receiving IV fluids.
we were out of money. she couldn't stay another night in the hospital without incurring a $210 charge the owner could not afford.
and so i sent her home.
but not before getting into a loud and extremely unprofessional (on the parts of all involved) argument with my senior clinician.
you see...our clinic gives away services all too often. we see these little old men and their best friends, or the young, engaged couple with no money and a puppy dying of parvo, or the financially strapped family with a hit by car dog, and they just don't have the finances to repair the beloved family pet. it breaks my heart. it breaks the heart of my intern-mates and senior doctors. we want to help. we really and truly do. and so we bend the charges here and there. knock off an hour of anesthesia for a surgery (a whopping $100). and an animal receives care and goes on to live another day.
the problem? there is no consistent standard. some people receive services much cheaper than others. and i'll be entirely honest - it has a lot to do with how the person treats my technicians, the front desk, and me. if they are respectful and understand the necessity of charging for the services we offer, i am much more likely to check the good samaritan box for drugs, slip them some subcutaneous fluids, or knock an ICU level 2 charge down to an ICU level 1.
but i've decided i'm finished with that. after the argument that ensued tonight, where i was accused of trying to make an example of a little old man, i decided that from now on, i charge for my services. if people can't afford to do what needs to be done, then i do what they can afford, and the rest is up to god or buddha or whoever.
after all, if i tried to run a veterinary business based on charity - i would quickly be bankrupt.
it may sound harsh, but tonight - in that position - i realized that it must be this way, else the system breaks down.
i'm sitting here at 5am unable to sleep (likely because i slept most of today). i've been playing on facebook. this is my new and total waste of time entertainment. hey - it's cheap! i just started a new album on my facebook - pictures of family functions. sitting here, going through the literally thousands of pictures from the last 4 years of my life (when i acquired my first real digital cam), i am moved by the photos.
what is so moving? perhaps you wonder. it stems from this: just 2 days ago, i read an article about modern day slavery. it was fascinating, compelling, and terribly sad. you can read it here (and i highly recommend it):
after finishing it, i sat for a while just thinking about the incomparable wealth that surrounds me. i'm not speaking only of the material wealth here - although i am surrounded by that in abundance, as well. i'm talking about the immaterial things. i have friends that love me, that care about my well-being, that i love. i have not one but two families - my own and that of my husband. they are both different and wonderful, and i love them both more than trite words or cliches can convey.
i've been a little sad tonight. i was looking at pictures of thanksgiving and christmas four years ago, and i came across pictures of my beautiful cousin. for those of you who started reading after i did a "blog cleanse" (i erase all old posts about once a year) - you probably don't know that my 2 year old cousin drowned in a terrible accident 3 years ago this past december. it was a shock my family weathered together. looking at his pictures tonight broke my heart a little. he was a beautiful little boy with a gorgeous smile, and we all loved him dearly. his funeral was attended by 300+ people. there wasn't room enough in the church. my uncle and aunt are extremely active in that church as are my grandparents. i've been going there with them since i was too young to remember. last year alone, they donated greater than $40,000 to the church (my uncle is a CEO). crosby and my family are loved. that outpouring was evident at his funeral.
it is evident every time i look at these pictures. i am blessed in every possible way that someone can be blessed. i have done nothing to deserve this richness in my life, and yet i have it.
i try to remind myself of that fact every single day - every sad day at work, every stressful moment, i look to what i have and take strength from that. i live in a nation of riches, i am free, i have 2 families to which i can always turn, i am never alone - no matter how sad i feel.
i'm relaxing on my THREE HOUR LUNCH BREAK and taking a moment to blog. yes, i am working relief work again at a local, absolutely gorgeous veterinary clinic. i'm not sure how long the clinic - in this incarnation - has been open, but it is beautiful, clean, organized, and spacious. the exam rooms are pleasant, well-stocked, and cheery. in short - i love this place. alas, i do not think they are hiring.
i am at home, just enjoyed lunch with my better half, and i am LOVING this.
every time i work day practice, i again marvel at how much i enjoy it. yes, vaccinations and skin are rather dull. but today, i've already had 2 interesting cases - a little miniature breed dog with severe cervical pain and an older (9 years) female german shepherd that is wobbling in the rear. i heavily suspect a slipped disc in the former and german shepherd myelopathy in the latter. those aren't your routine vaccines.
i won't bore anyone with the pro/con list for day practice AGAIN. instead, i'll just say that i certainly haven't ruled anything out for next year...except a residency.
ummmm....so i had an interesting case on new year's eve. i'll post about it later. it had a happy ending, by the way - so it won't be a vintage depressing homeless parrot post.
Any similarity between my stories and any person or animal, living or dead, is strictly a coincidence. Names, breeds, sexes, and details of the stories have been changed to protect the guilty and innocent alike.
I am an emergency veterinarian in North Carolina. Despite the crazy people I deal with, the awful cases of injured and sick animals, and the overall stress of emergency work, I absolutely love what I do. Happily married since I was 20, I have a wonderful husband who has a PhD in Mathematics, and a daughter around whom our world currently revolves. We also have a zoo living in our house that can be alternately wonderful and maddening. There are cats, parrots, and a dog who is very low on the totem pole. Our days are never dull and we are learning to balance the demands of work and family.
If you'd like to contact me: email@example.com
Azotemia - elevation in kidney enzymes (BUN and creatinine) indicating dehydration, kidney failure, or urinary obstruction
Lactate - a salt/ester of lactic acid that is produced as energy for a cell when oxygen levels are low. In critically ill animals, elevated lactate can be an indicator of inadequate blood flow to organs (perfusion), decreased delivery of oxygen, and/or decreased oxygen uptake. Values > 6-7 are usually considered to be poor prognostic indicators for survival.
GI sloughing: when the cells lining the GI tract die (can be secondary to MANY things, including heatstroke) with resulting bloody diarrhea, bacterial translocation into the bloodstream and sepsis
TTJ: transfer to jesus: code for when an animal needs to be euthanized or die
DIC: disseminated intravascular coagulation: a very, very bad thing - when the hemostatic system gets out of whack, and clots start forming in the blood vessels until all clotting factors are wasted. once those are gone, internal hemorrhage ensues, followed by death, usually. also known as "death is coming"
Pleural effusion - fluid contained in the pleural space (chest) - this is not the same as fluid in the lungs (see pulm edema) - in cats can be caused by infection in the chest, heart failure, cancer, FIP, feline leukemia, FIV, and in some cases, the cause is never found (idiopathic)
Anisocoria - unequal pupil size (related to any number of causes including brain damage/head trauma)
Laterally recumbent - lying on side, unable to rise
Hyperglycemia - elevated blood glucose
Hyperkalemia: elevated blood potassium - a life-threatening condition related to several disorders (kidney failure, antifreeze toxicity, urethral obstruction...etc)
Sepsis - refers to a bacterial infection in the bloodstream or body tissues. This is a very broad term covering the presence of many types of microscopic disease-causing organisms.
Nephrectomy - kidney removal
Splenectomy - removal of spleen
Pulmonary edema - condition in which fluid accumulates in the lungs, usually because the heart's left ventricle does not pump adequately ( can be caused by heart failure, electrocution, drowning, too many IV fluids, to name a few)
Tick borne diseases - any of a myriad of diseases transmitted by ticks - including but not limited to Rocky Mtn Spotted fever, Lyme disease, Ehrlichia
Fine needle aspirate - A method of sampling in which a needle is used to suck in cells or tissue bits for diagnoses (good for diagnosing masses/lumps)
Blood glucose - The principal sugar produced by the body from food–especially carbohydrates, but also from proteins and fats; glucose is the body's major source of energy, is transported to cells via the circulation and used by cells in the presence of insulin (normal range in a dog/cat is 75-100)
PCV - packed cell volume - the volume of packed red cells in milliliters per 100 ml of blood (normal range 35-45)
Diseases I see/treat frequently
Dystocia - difficulty birthing. May be responsive to oxytocin administration (Pitocin, as in people) but may require c-section.
DKA - diabetic ketoacidosis: the extreme end of the diabetic scale. A patient that is diabetic can develop DKA when other diseases make the blood glucose hard to regulate. Other diseases that are commonly associated include urinary tract infection, pancreatitis, pyometra, skin infection, and cancer. In DKA, the body starts metabolizing fat and producing acids that cause a drop in blood pH, nausea, weakness, severe dehydration, electrolyte derangments, and death.
DCM - dilated cardiomyopathy: an idiopathic (cause unknown) cardiac disease in which the heart chambers become very thin/dilated, and cardiac output drops radically. Causes arrhythmias, tachycardia, and sudden death. Seen in large breed dogs like Dobermans, Great Danes, etc.
Lymphoma - cancer of the white blood cells, the most common and treatable form of cancer in dogs
Blocked cat - slang term for a male cat with a plug of mucus and crystals obstructing the urethra (fairly common in male cats) definitely a life-threatening because urine can't get out of the body! If present long enough, causes shock, acute renal failure, hyperkalemia (elevated potassium), coma, and death. Symptoms include straining in the litterbox, yowling while trying to urinate, producing small, bloody drops of urine (also symptoms of feline cystitis, a non-lethal condition)
GDV - stands for gastric-dilatation and volvulus - a condition of large breed, deep-chested dogs (usually) in which the stomach rotates 180 degrees on its axis and thus - nothing can enter or leave, considered the "mother of all emergencies" - it warrants immediate surgery and carries a guarded prognosis
IMHA - immune-mediated hemolytic anemia. A disease in which the immune system attacks the red blood cells and destroys them. It causes profound anemia and is life-threatening. Causes are primary (no known cause) and secondary ( tick borne disease, cancer, and heavy metal intoxication). Treatment is immunosuppression with drugs primarily. Prognosis is guarded at best.