The winter months are firmly upon us. I saw 2 patients last night.
Sunday was a rough day. I worked the day shift - which is from 8:30am-6pm. I didn't leave work until 10pm, unfortunately. It was a busy day, and I couldn't keep up with my medical records, thus necessitating a stay long after hours to finish them. Further, I had a patient with a case that I STILL haven't gotten a handle on. I posted about it on VIN, picked the brains of my colleagues, and have spent a few hours pouring over textbooks trying to find ANY explanation for what happened to this cat. Nothing has been fruitful. It was incredibly, incredibly frustrating, because he died about 6 hours after admission to the hospital.
His condition was extremely critical when he came in. He was in shock. His body temperature was 90 degrees (normal 99-101), his HR was 96 (normal should 180-220), his blood glucose was 40! (normal 85-300 for a sick cat), and he was as limp as a dishrag. I told the owners that it didn't look good and told them that I would be referring the cat to a specialist in the morning when he was stable enough to survive the drive. Unfortunately, I lost him. It was rather devastating.
Alas, 6 more days of work straight, then I can turn into a mental vegetable.
Tuesday, November 30, 2010
Saturday, November 27, 2010
Friday, November 26, 2010
I have added some additional comments to the good vet v. bad vets post. Thank you for the responses, and I will try to post my replies in the next few days. As of tomorrow morning at 8am, I am working 9 days in a row (picking up a couple of relief shifts at a nearby 24 hour clinic). So, it might take me a bit!
Caveat emptor
I realized with a start this morning after leaving work that I have never really talked about veterinarians and how to choose one or NOT to choose one. Nor have I ever really talked about the vast differences in how medicine is practiced.
The general population seems to be under the mistaken impression that all veterinarians are the same in terms of quality. This is as ridiculous as thinking that all human doctors are the same. It's just patently untrue. Veterinarians run the gamut from incredibly motivated, intelligent, inquisitive individuals with a drive to pursue excellence and do the best they can for their patients to those veterinarians who could care less as long as they receive a steady paycheck to those veterinarians that hate what they do and take it out on the animals (and everything possible in between).
I was 19 when I first worked for a veterinarian. I had taken a year off of college between freshman and sophomore year, moved home, moved in with my boyfriend (later to become my husband), and was looking for work. I took a job as a receptionist at a local veterinary clinic. My duties were manifold and included not only reception work but occasionally assisting the doctor. It was there that I was first exposed to veterinarians.
The vet I worked for was in his mid-40s. His wife was the office manager. She was bitter and spiteful; he was a jerk. He regularly made sexually suggestive comments towards me. That I could handle (although all of my natural instincts now cry out against it). It was the beating animals that drove me away. He would lose his temper with an unruly animal and out of nowhere, lash out. I once saw him grab a biting chihuahua, pin it in the corner of its cage, and punch it repeatedly. Another time, he was annoyed with a goofy Cocker spaniel, so he used its leash to sling it against the wall.
I was a coward and did nothing. Voicing my strong objection to this man would have probably led to my being fired on the spot. Further, I just wasn't as confrontational and confident in myself as I am now. I was 19. Looking back, I sincerely regret that I did not intervene or report him to someone. Needless to say, that job lasted 6 months. I still drive by that clinic on my way to my parent's house and think about what I observed there. I also think about reporting him - even now. It would be my word against his, and he is well-respected in my small hometown. That experience formed me so strongly that I will not even tolerate my technicians speaking harshly to an animal or calling an animal names when they lose their tempers. Forget about ever doing anything malicious or even over-restraining in my presence. It is not tolerated.
When vet school started, my expectation was to be surrounded by excellence. And for the most part, my classmates were driven, intelligent, and caring individuals that I would trust with my pet. There were a handful however that scared the living daylights out of me. People that seemed to have no interest in animals, that didn't even seem to like them or want to touch them; students that didn't care about grades, personal achievement, or learning anything.
I could regale you with these types of horror stories for hours, but the point of this post was not to scare you away from veterinarians. I want to alert my non-vet readers that NOT all veterinarians are the same. There are definitely quality differences. My goal is to help you guys figure out who is doing a good job, who is doing an excellent job, and who hasn't kept up on their CE and has no interest in offering top quality medicine. Since this post is already running toward my typically long-ish format, I'll save details for the next post.
The general population seems to be under the mistaken impression that all veterinarians are the same in terms of quality. This is as ridiculous as thinking that all human doctors are the same. It's just patently untrue. Veterinarians run the gamut from incredibly motivated, intelligent, inquisitive individuals with a drive to pursue excellence and do the best they can for their patients to those veterinarians who could care less as long as they receive a steady paycheck to those veterinarians that hate what they do and take it out on the animals (and everything possible in between).
I was 19 when I first worked for a veterinarian. I had taken a year off of college between freshman and sophomore year, moved home, moved in with my boyfriend (later to become my husband), and was looking for work. I took a job as a receptionist at a local veterinary clinic. My duties were manifold and included not only reception work but occasionally assisting the doctor. It was there that I was first exposed to veterinarians.
The vet I worked for was in his mid-40s. His wife was the office manager. She was bitter and spiteful; he was a jerk. He regularly made sexually suggestive comments towards me. That I could handle (although all of my natural instincts now cry out against it). It was the beating animals that drove me away. He would lose his temper with an unruly animal and out of nowhere, lash out. I once saw him grab a biting chihuahua, pin it in the corner of its cage, and punch it repeatedly. Another time, he was annoyed with a goofy Cocker spaniel, so he used its leash to sling it against the wall.
I was a coward and did nothing. Voicing my strong objection to this man would have probably led to my being fired on the spot. Further, I just wasn't as confrontational and confident in myself as I am now. I was 19. Looking back, I sincerely regret that I did not intervene or report him to someone. Needless to say, that job lasted 6 months. I still drive by that clinic on my way to my parent's house and think about what I observed there. I also think about reporting him - even now. It would be my word against his, and he is well-respected in my small hometown. That experience formed me so strongly that I will not even tolerate my technicians speaking harshly to an animal or calling an animal names when they lose their tempers. Forget about ever doing anything malicious or even over-restraining in my presence. It is not tolerated.
When vet school started, my expectation was to be surrounded by excellence. And for the most part, my classmates were driven, intelligent, and caring individuals that I would trust with my pet. There were a handful however that scared the living daylights out of me. People that seemed to have no interest in animals, that didn't even seem to like them or want to touch them; students that didn't care about grades, personal achievement, or learning anything.
I could regale you with these types of horror stories for hours, but the point of this post was not to scare you away from veterinarians. I want to alert my non-vet readers that NOT all veterinarians are the same. There are definitely quality differences. My goal is to help you guys figure out who is doing a good job, who is doing an excellent job, and who hasn't kept up on their CE and has no interest in offering top quality medicine. Since this post is already running toward my typically long-ish format, I'll save details for the next post.
How to know a good veterinarian from a bad one
So, I am going to talk about what separates the good from the bad. Some pertains specifically to ER medicine, some to both GPs and ER. I'll elaborate as I go.
A good veterinarian does a full physical exam - whether at an annual exam for vaccines or at a sick patient exam. This is a head-to-toe exam that should include listening to the heart and lungs, feeling all the lymph nodes, palpating the abdomen, examining the head and mouth, a rectal exam, a full set of vitals, and a weight.
There are 12 important things that can be learned from a rectal (such as the presence of malignant rectal cancer or prostatomegaly in older pets). So if your vet isn't checking there, request that they put on a glove and find the lube.
A good (especially ER) veterinarian takes a thorough history and listens carefully while doing it. This includes any medications your pet is currently on or that you might have administered at home, any previous medical history whether related to the current problem or not, and a myriad of other questions.
A good veterinarian recommends diagnostic testing for a problem with no obvious cause. If the owner cannot afford diagnostics, a good veterinarian will carefully select the safest treatment that will be the most efficacious.
A good veterinarian vaccinates on a 3 year schedule. It is well-known and accepted in veterinary medicine that yearly vaccines are not necessary or healthy, and that they may contribute to the development of immune disease in cats and dogs.
(I won't say that bad veterinarians vaccinate yearly. It is taking the veterinary community a long time to come around on this subject, and many otherwise excellent veterinarians are still doing once a year vaccines. Become informed before having your pet vaccinated yearly! Know what vaccines are required by law (rabies), recommended for your animal's particular lifestyle (such as FeLV/FIV for outdoor cats), and know what is not recommended.)
A good veterinarian is a member of VIN or another continuing education/learning site, is interested in getting help with cases from colleagues, and refers when a case is not going well and could use the services of a specialist (owner finances allowing, of course). Many good vets aren't members of VIN, but I believe one hallmark of an interested, informed veterinarian is a VIN membership (or the equivalent for large animal and other non-small animal veterinarians).
A good (GP) veterinarian offers overnight care to any ill, post-operative, or injured animal - especially if they are painful, require IV fluids, or any monitoring. Many owners cannot afford this, but the offer should always be made.
A good veterinarian keeps excellent, legible records. Whether hand-written or typed, they should follow a general SOAP format : subjective (physical exam, history, overall patient assessment), objective (hard data such as labwork, xrays, etc), assessment (differential diagnosis, other recommended testing), and plan (medications prescribed and administered, fluids given, etc). Every day an animal is in the hospital, a new SOAP should be done. If another veterinarian can't clearly follow the notes and understand them (or READ THEM, in some cases), your pet could suffer the consequences.
A good veterinarian will inform owners if a mistake that affects their pet's health or safety has been made.
What do I think is not necessarily an indicator of a good veterinarian?
Bedside matter doesn't mean doodly-squat, to be perfectly frank. I know some well-loved veterinarians that are complete and total quacks. I also know some harsh, abrasive doctors that are excellent clinicians.
** Addendum: I meant to say that bedside matter does not necessarily correlate with capability as a doctor. I know some very cold fish doctors that are brilliant. If your vet doesn't mesh with you...but does a good job, I would personally choose to stick with that - but that's just me.
Your veterinarian should be concise, explain any medical problems clearly, have a list of possible differentials if the cause for illness is unclear, and a clear plan of attack for treatment and further testing. We don't always have the answers, but a veterinarian should be up front about that. Owners should know that we don't always know either - but we will try our darndest to figure it out. If not - you should be given a referral.
A good veterinarian selects excellent pain control for any procedure that is painful. Butorphanol ("torb") is no longer considered acceptable premedication for a painful procedure. Studies have shown that its analgesic properties last only about 30 minutes to an hour. A pure mu opioid (like hydromorphone, morphine, oxymorphone, or fentanyl) should be coupled with a sedative/tranquilizer like acepromazine, Valium, Domitor, or midazolam for pre-medication/pain control.
A good veterinarian has someone monitoring anesthesia during surgery. This includes monitoring blood pressure, oxygenation, end-tidal carbon dioxide, and heart rate. More importantly - the PATIENT should be monitored - gum color should be checked, pulses periodically assessed, and auscultation of the lungs and heart should be done.
A good veterinarian takes the time to educate owners on the "whys" of preventative care, diagnostic testing, and treatment plans. This may extend to giving owners hand-outs with information that they can take home to read. (I do this frequently, as diagnosing disease in the ER can be very stressful for owners, and they do not always fully absorb information.)
I could go on in this vein for hours on end, but this is a good starting point. Let me know what you guys think...what have you found has been most important to you in a veterinarian - and what has turned you off most about a veterinarian?
A good veterinarian does a full physical exam - whether at an annual exam for vaccines or at a sick patient exam. This is a head-to-toe exam that should include listening to the heart and lungs, feeling all the lymph nodes, palpating the abdomen, examining the head and mouth, a rectal exam, a full set of vitals, and a weight.
There are 12 important things that can be learned from a rectal (such as the presence of malignant rectal cancer or prostatomegaly in older pets). So if your vet isn't checking there, request that they put on a glove and find the lube.
A good (especially ER) veterinarian takes a thorough history and listens carefully while doing it. This includes any medications your pet is currently on or that you might have administered at home, any previous medical history whether related to the current problem or not, and a myriad of other questions.
A good veterinarian recommends diagnostic testing for a problem with no obvious cause. If the owner cannot afford diagnostics, a good veterinarian will carefully select the safest treatment that will be the most efficacious.
A good veterinarian vaccinates on a 3 year schedule. It is well-known and accepted in veterinary medicine that yearly vaccines are not necessary or healthy, and that they may contribute to the development of immune disease in cats and dogs.
(I won't say that bad veterinarians vaccinate yearly. It is taking the veterinary community a long time to come around on this subject, and many otherwise excellent veterinarians are still doing once a year vaccines. Become informed before having your pet vaccinated yearly! Know what vaccines are required by law (rabies), recommended for your animal's particular lifestyle (such as FeLV/FIV for outdoor cats), and know what is not recommended.)
A good veterinarian is a member of VIN or another continuing education/learning site, is interested in getting help with cases from colleagues, and refers when a case is not going well and could use the services of a specialist (owner finances allowing, of course). Many good vets aren't members of VIN, but I believe one hallmark of an interested, informed veterinarian is a VIN membership (or the equivalent for large animal and other non-small animal veterinarians).
A good (GP) veterinarian offers overnight care to any ill, post-operative, or injured animal - especially if they are painful, require IV fluids, or any monitoring. Many owners cannot afford this, but the offer should always be made.
A good veterinarian keeps excellent, legible records. Whether hand-written or typed, they should follow a general SOAP format : subjective (physical exam, history, overall patient assessment), objective (hard data such as labwork, xrays, etc), assessment (differential diagnosis, other recommended testing), and plan (medications prescribed and administered, fluids given, etc). Every day an animal is in the hospital, a new SOAP should be done. If another veterinarian can't clearly follow the notes and understand them (or READ THEM, in some cases), your pet could suffer the consequences.
A good veterinarian will inform owners if a mistake that affects their pet's health or safety has been made.
What do I think is not necessarily an indicator of a good veterinarian?
Bedside matter doesn't mean doodly-squat, to be perfectly frank. I know some well-loved veterinarians that are complete and total quacks. I also know some harsh, abrasive doctors that are excellent clinicians.
** Addendum: I meant to say that bedside matter does not necessarily correlate with capability as a doctor. I know some very cold fish doctors that are brilliant. If your vet doesn't mesh with you...but does a good job, I would personally choose to stick with that - but that's just me.
Your veterinarian should be concise, explain any medical problems clearly, have a list of possible differentials if the cause for illness is unclear, and a clear plan of attack for treatment and further testing. We don't always have the answers, but a veterinarian should be up front about that. Owners should know that we don't always know either - but we will try our darndest to figure it out. If not - you should be given a referral.
A good veterinarian selects excellent pain control for any procedure that is painful. Butorphanol ("torb") is no longer considered acceptable premedication for a painful procedure. Studies have shown that its analgesic properties last only about 30 minutes to an hour. A pure mu opioid (like hydromorphone, morphine, oxymorphone, or fentanyl) should be coupled with a sedative/tranquilizer like acepromazine, Valium, Domitor, or midazolam for pre-medication/pain control.
A good veterinarian has someone monitoring anesthesia during surgery. This includes monitoring blood pressure, oxygenation, end-tidal carbon dioxide, and heart rate. More importantly - the PATIENT should be monitored - gum color should be checked, pulses periodically assessed, and auscultation of the lungs and heart should be done.
A good veterinarian takes the time to educate owners on the "whys" of preventative care, diagnostic testing, and treatment plans. This may extend to giving owners hand-outs with information that they can take home to read. (I do this frequently, as diagnosing disease in the ER can be very stressful for owners, and they do not always fully absorb information.)
I could go on in this vein for hours on end, but this is a good starting point. Let me know what you guys think...what have you found has been most important to you in a veterinarian - and what has turned you off most about a veterinarian?
Thursday, November 25, 2010
Oh come on! Someone step up here...
First night back was fun, of course. Isn't it always?
I'm in a room talking to a client about her dog's impending surgery when I hear my name yelped out by a technician in the ICU. I exited the exam room in a hurry to find my technicians working frantically on a hit by car dog.
Said dog weighed about 15 pounds, and her pelvis was on backwards. In less silly terms, she obviously had fractured her spine, as she was completely limp from the waist down. She had bright red blood coming out of her vulva and was in severe shock. Her condition was extremely critical, and my technicians had already placed oxygen by face mask and an IV catheter.
There were FOUR adults with this dog. FOUR. The owner was in another state. Presenting the dog were the owner's father, her brother, a sister, and possibly a sister-in-law. We told them $500 to get started on stabilization and diagnostics. They declined. No money, they cried.
"Fine," I replied. "Please have whoever is making the financial and medical decisions come back here so that I can discuss the situation while monitoring the dog" (who got a whopping dose of pain medications at that point, despite the financial situation). My tech went to get someone. Minutes passed. No one came. The door alarm rang multiple times as the 4 people rushed in and out, making phone calls, standing around discussing. They consulted. No one would fill out the required paperwork, and no one would come talk to me. I stood there, tied to the patient, because my other tech was in isolation caring for 2 very sick parvovirus dogs.
Finally, the owner's brother came back. "Uh, yeah, we're going to take her (the dog) to another vet up the road in X town."
My reply, "uh, no sir, you're not. He is closed for the holiday. There are no other veterinarians open at this hour and on a holiday eve. This dog is severely injured with a guarded to grave prognosis. You either need to commit to diagnostics and treatment (what treatment options there are) or euthanasia. This dog is NOT leaving the clinic."
He mumbled, "my dad is making the decisions." I politely requested that he get his father.
More minutes pass. It has now been almost an hour since the dog presented. I have 3 patients with paying owners that are waiting for their IV catheters, fluids, and further testing that cannot be attended to because these people are running in and out of the front door, making a scene, and basically throwing a huge wrench into the flow of our small clinic. I spend another 10 minutes waiting.
Finally, I march out the front door, furious. They are all standing around. "I need you," I say firmly and point to the father. He trails me reluctantly to the ICU where I give him the same talk. He says his daughter (in Florida) is hysterical and cannot make a decision. I tell him the decision is clear if finances are a concern. It may be clear even if they have a million dollars.
"I have to talk to my daughter," he says, and out the door he moseys.
At this point, I am purple. The dog is suffering, needs to be euthanized, and not one - not A SINGLE FREAKING ONE - of these adults will step up to the plate, procure a small amount of money for me to do the humane thing (or a larger amount to do some diagnostics and confirm my suspicions).
At this point, it has been over an hour and 15 minutes, and I am sick and tired of my paying clients that need care being ignored. I march back out front and tell the whole group they need to make a decision. The sister-in-law says, "Why can't we just take her home and let her die there?"
My gut response was this, "If you were hit by a car, broken practically in two, and in shock, would it be ok if your family took you home to let you die??????" I was horrified, but I did not actually say this. I sort of wish I had.
In the end, I euthanized the dog for free. I had no intentions of leaving it to suffer, whatever the owners financial situation. They paid the exam room fee and nothing else, despite the treatment we initiated. Then...oh THEN...they had the gall to try and request private cremation afterwards - which costs $200! I told them in no uncertain terms that before we could proceed with private cremation, they would need to pay for the IV catheter, pain medications, oxygen, and fluids we had already administered to their dog to ease its pain and treat its shock.
Oh, the backpedaling that occurred then. The dog was taken home to be buried.
Seriously?? Look, I understand not wanting to plunk down $500 on someone else's dog, but for the love of God, between 4 adults ranging in ages from 32 to 75, you cannot produce $200 to do the right thing for your daughter's/sister's pet??
It was not a good start to the night. Thankfully, while we stayed busy last night, we had no other real "excitement."
I'm in a room talking to a client about her dog's impending surgery when I hear my name yelped out by a technician in the ICU. I exited the exam room in a hurry to find my technicians working frantically on a hit by car dog.
Said dog weighed about 15 pounds, and her pelvis was on backwards. In less silly terms, she obviously had fractured her spine, as she was completely limp from the waist down. She had bright red blood coming out of her vulva and was in severe shock. Her condition was extremely critical, and my technicians had already placed oxygen by face mask and an IV catheter.
There were FOUR adults with this dog. FOUR. The owner was in another state. Presenting the dog were the owner's father, her brother, a sister, and possibly a sister-in-law. We told them $500 to get started on stabilization and diagnostics. They declined. No money, they cried.
"Fine," I replied. "Please have whoever is making the financial and medical decisions come back here so that I can discuss the situation while monitoring the dog" (who got a whopping dose of pain medications at that point, despite the financial situation). My tech went to get someone. Minutes passed. No one came. The door alarm rang multiple times as the 4 people rushed in and out, making phone calls, standing around discussing. They consulted. No one would fill out the required paperwork, and no one would come talk to me. I stood there, tied to the patient, because my other tech was in isolation caring for 2 very sick parvovirus dogs.
Finally, the owner's brother came back. "Uh, yeah, we're going to take her (the dog) to another vet up the road in X town."
My reply, "uh, no sir, you're not. He is closed for the holiday. There are no other veterinarians open at this hour and on a holiday eve. This dog is severely injured with a guarded to grave prognosis. You either need to commit to diagnostics and treatment (what treatment options there are) or euthanasia. This dog is NOT leaving the clinic."
He mumbled, "my dad is making the decisions." I politely requested that he get his father.
More minutes pass. It has now been almost an hour since the dog presented. I have 3 patients with paying owners that are waiting for their IV catheters, fluids, and further testing that cannot be attended to because these people are running in and out of the front door, making a scene, and basically throwing a huge wrench into the flow of our small clinic. I spend another 10 minutes waiting.
Finally, I march out the front door, furious. They are all standing around. "I need you," I say firmly and point to the father. He trails me reluctantly to the ICU where I give him the same talk. He says his daughter (in Florida) is hysterical and cannot make a decision. I tell him the decision is clear if finances are a concern. It may be clear even if they have a million dollars.
"I have to talk to my daughter," he says, and out the door he moseys.
At this point, I am purple. The dog is suffering, needs to be euthanized, and not one - not A SINGLE FREAKING ONE - of these adults will step up to the plate, procure a small amount of money for me to do the humane thing (or a larger amount to do some diagnostics and confirm my suspicions).
At this point, it has been over an hour and 15 minutes, and I am sick and tired of my paying clients that need care being ignored. I march back out front and tell the whole group they need to make a decision. The sister-in-law says, "Why can't we just take her home and let her die there?"
My gut response was this, "If you were hit by a car, broken practically in two, and in shock, would it be ok if your family took you home to let you die??????" I was horrified, but I did not actually say this. I sort of wish I had.
In the end, I euthanized the dog for free. I had no intentions of leaving it to suffer, whatever the owners financial situation. They paid the exam room fee and nothing else, despite the treatment we initiated. Then...oh THEN...they had the gall to try and request private cremation afterwards - which costs $200! I told them in no uncertain terms that before we could proceed with private cremation, they would need to pay for the IV catheter, pain medications, oxygen, and fluids we had already administered to their dog to ease its pain and treat its shock.
Oh, the backpedaling that occurred then. The dog was taken home to be buried.
Seriously?? Look, I understand not wanting to plunk down $500 on someone else's dog, but for the love of God, between 4 adults ranging in ages from 32 to 75, you cannot produce $200 to do the right thing for your daughter's/sister's pet??
It was not a good start to the night. Thankfully, while we stayed busy last night, we had no other real "excitement."
Wednesday, November 24, 2010
In kitten news...
My last "batch" have all been adopted out. Gorgeous orange boy went to a very animal oriented family. He will be loved by a teenage boy whose kitty died recently from renal failure. They were very sweet together. The torbie and dilute calico became BFFs after he left, and they stayed with us longer than any of our previous bottle babies. Letting them go was very, very hard. They had gotten big enough to roam the house. They slept with us every night, danced the Mexican hat dance on my head promptly at 7am every morning (which made me want to murder them), and kept me company during naps and movie time. They were both unbelievably sweet and purred when in close proximity to any human.
Alas, I had to let them go. They went to a young teacher (mid-20s) who was so excited to meet them that she brought her parents along too. They will have a wonderful, indoor only life with a loving cat mommy. She emailed me 3 times about the settling in process and included pictures of them.
No more kittens for now. And holy geez, I cannot believe I typed those words. Tonight, I go back to work. I just opened the kitten Pandora's box! Signing off now! (A comparison picture of how teeny they were just a couple of month's ago)
Tuesday, November 23, 2010
Monday, November 22, 2010
Interesting dilemma for me...
So, I have question I would like to pose to my readers:
Would you leave the perfect job because you didn't live in the perfect area? Would you willingly plunge into the unknown (a new job), go through the hell of the initial settling in period, just to be closer to your family and to be IN the mountains instead of a flat (but pretty) urban area?
I ask these questions for a couple of reasons. First and foremost, our amazing office manager, after 5 years at my clinic, has been offered a position elsewhere. She would be making twice what she is now, she would have full benefits (including life insurance and disability, which our small clinic cannot offer), and she would be doing something new. She has pretty much hit a ceiling at our clinic as far as what else she can do. There are many reasons that she is ready to move on. It's an amazing offer for her, and I couldn't be happier. FOR HER. On the other hand, it will be a blow to us. It's hard to find a good office manager, let alone a great one.
Coupled with that, I recently saw an ad in JAVMA for an ER veterinarian in a 24 hour facility. This place is absolutely gorgeous and has won many awards for hospital design. It is nestled in the heart of western NC. An hour's drive from home, 15 minutes from my brother, his wife, and my rapidly growing 2 year old niece. It's 15 minutes from all of my husband's kayaking friends, and there is abundant kayaking for the man. It is also a much, much shorter commute to UT for my husband. Thus, he could see his thesis advisor much more frequently and without being gone for long stretches of time. The pay is commensurate with what I make here.
So those are the pros.
The cons: we just bought our house a year and a half ago (approx). It's a bad market, and we would lose money when we sold it. Also, we would have to pay back the tax credit we received from the government ($8,000). IF I even got the job, I would have to go through the initial settling in period. That is never easy for me. I am not a laid back person, and technicians and fellow doctors don't know how to take me at first. It took me a full year before I even felt like a real member of the team here. I know absolutely nothing about the medicine practiced at the clinic, nor do I know anything about the clinic itself - other than it's beautiful, and they are obviously interested in progressive medicine, as they have an acupuncturist.
So, what do ya'll think? Stay with what is comfortable and really good (I love my job, I love my team, I have a great schedule, and I make really good money)? Or plunge into the unknown of a new job?
I've already decided what I'm going to do, but I am interested in the opinions of others.
Would you leave the perfect job because you didn't live in the perfect area? Would you willingly plunge into the unknown (a new job), go through the hell of the initial settling in period, just to be closer to your family and to be IN the mountains instead of a flat (but pretty) urban area?
I ask these questions for a couple of reasons. First and foremost, our amazing office manager, after 5 years at my clinic, has been offered a position elsewhere. She would be making twice what she is now, she would have full benefits (including life insurance and disability, which our small clinic cannot offer), and she would be doing something new. She has pretty much hit a ceiling at our clinic as far as what else she can do. There are many reasons that she is ready to move on. It's an amazing offer for her, and I couldn't be happier. FOR HER. On the other hand, it will be a blow to us. It's hard to find a good office manager, let alone a great one.
Coupled with that, I recently saw an ad in JAVMA for an ER veterinarian in a 24 hour facility. This place is absolutely gorgeous and has won many awards for hospital design. It is nestled in the heart of western NC. An hour's drive from home, 15 minutes from my brother, his wife, and my rapidly growing 2 year old niece. It's 15 minutes from all of my husband's kayaking friends, and there is abundant kayaking for the man. It is also a much, much shorter commute to UT for my husband. Thus, he could see his thesis advisor much more frequently and without being gone for long stretches of time. The pay is commensurate with what I make here.
So those are the pros.
The cons: we just bought our house a year and a half ago (approx). It's a bad market, and we would lose money when we sold it. Also, we would have to pay back the tax credit we received from the government ($8,000). IF I even got the job, I would have to go through the initial settling in period. That is never easy for me. I am not a laid back person, and technicians and fellow doctors don't know how to take me at first. It took me a full year before I even felt like a real member of the team here. I know absolutely nothing about the medicine practiced at the clinic, nor do I know anything about the clinic itself - other than it's beautiful, and they are obviously interested in progressive medicine, as they have an acupuncturist.
So, what do ya'll think? Stay with what is comfortable and really good (I love my job, I love my team, I have a great schedule, and I make really good money)? Or plunge into the unknown of a new job?
I've already decided what I'm going to do, but I am interested in the opinions of others.
Friday, November 19, 2010
Phew
I just chopped all of my hair off - 10 inches. I'm donating it to Locks of Love. It's quite a shock. It's also somewhat of a revelation of how vain I am, especially about my hair. It is naturally blonde, naturally soft, and I associated much of my feminine charm with it. Once it was gone, I felt a little...stripped, I guess. And more than a little boyish. It's silly, I realize. I'm glad that I did it and that someone with real hardship will benefit from it.
It grows back, right?
It grows back, right?
Wednesday, November 17, 2010
My formerly crippled Doberman
Now runs and chases her tennis ball until her tongue hangs out. My husband was running with her regularly, and she loved it. He's been busy with school, we were in Hawaii for a week, and then we came back, and I was busy with work, so she hasn't had nearly as much exercise as normal. Tonight, we took her to the park, long after dark, in the low 40 degree weather. The tennis courts were empty, so we closed the gates and threw the tennis ball to her heart's content.
It's amazing, watching this dog that could hardly hobble to a standing position in March go racing after her ball like a greyhound. If you'd seen her then - you wouldn't realize that this was the same dog.
I couldn't ask for a better dog.
It's amazing, watching this dog that could hardly hobble to a standing position in March go racing after her ball like a greyhound. If you'd seen her then - you wouldn't realize that this was the same dog.
I couldn't ask for a better dog.
Supreme inertia.
I'm trying to think of something to talk about, but I have such incredible inertia today that my brain feels like it is slogging through mud. It doesn't help that it's 1:30pm, and my husband is loudly snoring on the couch. I'm drowsy, and it's a beautiful day outside. I should be doing something. Instead, I've been sitting here making lists of things I need to do - Christmas shopping, picking up dog food...things I COULD be doing now. Instead, I make lists.
Monday, November 15, 2010
Oh, HELL NO.
So, this is one of the GREAT things that happened immediately upon my arrival back at work post-Hawaii:
You all remember this gut-wrenching case that had me questioning my medical and surgical decisions. I don't remember if I told the entire story - but the wife and husband could not have been more diametrically opposed. The wife wanted surgery at almost any cost and risk. The husband wanted to take the dog home and shoot it. As he told me (more than once), it was "just a dog."
The husband apparently called 3 times while I was gone, demanding a refund for surgery. He wanted to talk to the "little blonde doctor" who "raped him financially." Those were his words exactly. He accused me of taking the dog to surgery strictly for profit, knowing that the patient would die in surgery or shortly thereafter. There were many other accusations levied against me, but those were the strongest.
I got a note with the lengthy client communications detailed and our OM requesting that I call the male owner.
I called the night I came back to work. It was about 12 hours after I had received some very disturbing and upsetting news about a family member, and I was also in the post-amazing vacation funk, so I was very emotionally fragile. The male owner was sweet as pie on the phone with me, perhaps because he could hear that I was going to cry in my voice.
In all sincerity, I explained to him how sad I was that his dog had died, how terrible it felt not to be able to save him, basically, everything I outlined for you here. In the end, he said he felt I'd done nothing wrong, but that since the dog was dead, we should give him money back. I explained I had no control over that. He thanked me and said he would "take it up with the other lady" (our OM).
As it turns out, the owner actually recouped expenses from the man whose dog mauled his, so he was trying to MAKE money off his dog's misfortune. I believe my OM's exact words when I told her that he still wanted money back were "oh, HELL NO."
Then, the NEXT night at work, the wife came in to see me. She was not there to demand a refund. She was simply there to make sure that her dog had not died alone and scared. I felt for her, as I can imagine how hard it must be for people to leave seriously ill/dying pets in someone else's hands. To not be there with them when they die (although we tried to keep him alive without chest compressions so she could say goodbye) must be tremendously difficult. She was afraid that he had died scared. I assured her that we had been with him every step of the way, soothing him and easing his passing. This is absolutely true. I try to make sure every patient feels loved at the end, even those with no home and no owners. Even the squirrels.
*Sigh* I hope I've heard the last of this one.
You all remember this gut-wrenching case that had me questioning my medical and surgical decisions. I don't remember if I told the entire story - but the wife and husband could not have been more diametrically opposed. The wife wanted surgery at almost any cost and risk. The husband wanted to take the dog home and shoot it. As he told me (more than once), it was "just a dog."
The husband apparently called 3 times while I was gone, demanding a refund for surgery. He wanted to talk to the "little blonde doctor" who "raped him financially." Those were his words exactly. He accused me of taking the dog to surgery strictly for profit, knowing that the patient would die in surgery or shortly thereafter. There were many other accusations levied against me, but those were the strongest.
I got a note with the lengthy client communications detailed and our OM requesting that I call the male owner.
I called the night I came back to work. It was about 12 hours after I had received some very disturbing and upsetting news about a family member, and I was also in the post-amazing vacation funk, so I was very emotionally fragile. The male owner was sweet as pie on the phone with me, perhaps because he could hear that I was going to cry in my voice.
In all sincerity, I explained to him how sad I was that his dog had died, how terrible it felt not to be able to save him, basically, everything I outlined for you here. In the end, he said he felt I'd done nothing wrong, but that since the dog was dead, we should give him money back. I explained I had no control over that. He thanked me and said he would "take it up with the other lady" (our OM).
As it turns out, the owner actually recouped expenses from the man whose dog mauled his, so he was trying to MAKE money off his dog's misfortune. I believe my OM's exact words when I told her that he still wanted money back were "oh, HELL NO."
Then, the NEXT night at work, the wife came in to see me. She was not there to demand a refund. She was simply there to make sure that her dog had not died alone and scared. I felt for her, as I can imagine how hard it must be for people to leave seriously ill/dying pets in someone else's hands. To not be there with them when they die (although we tried to keep him alive without chest compressions so she could say goodbye) must be tremendously difficult. She was afraid that he had died scared. I assured her that we had been with him every step of the way, soothing him and easing his passing. This is absolutely true. I try to make sure every patient feels loved at the end, even those with no home and no owners. Even the squirrels.
*Sigh* I hope I've heard the last of this one.
Friday, November 12, 2010
Don't throw your pen at me...
So along the lines of the "yank my hair out/knitting in a closet" stories, 4am Wednesday morning rolls around. Someone starts yanking and banging on the door. That's never a good sign, since the signs on the door clearly state that it is locked after midnight and to ring the CLEARLY marked doorbell. I go to the front (my tech had her hands full with a patient). Standing outside is a couple that is...well, what I call a K-town special. Quintessential white trash, mid-20s. In the woman's arms is a small breed dog that is tremoring all over. I diagnosed the patient THROUGH the glass.
As she came in, I asked her, "when were her puppies born?"
"Two weeks ago," she replied.
I briefly explained that her dog was exhibiting signs of eclampsia ("milk fever") and that she needed emergency treatment. I explained the exam fee of $92. She glared at me, and said, "I guess that other check will just have to bounce, then."
I should have known what was coming at that point, but I went ahead and took the dog from her and headed to the back. My tech was waiting.
"$250 deposit up front," I said. Eclampsia is pretty easy and cheap to fix (as I've said here before). It's an emergency I have a hard time not treating, even when the owners have "no" money (i.e. refuse to spend it on their pet instead of their cigarettes and cell phones). She disappeared up front while I started getting vitals on the tremoring dog.
All of a sudden, I heard a flat bang and then the unmistakable skitter of a pen across the linoleum. Moments later, my technician reappeared.
"She wants her dog back NOW," she said. "Oh, and she threw the pen across the counter at me."
I marched up front and handed the dog to the owner. "You said it would only be $92," she accused me, as she turned to storm out the front door. "I got 6 kids, and I can't afford no $250-300."
As she's pushing out the door, I seethed inside, but flatly and without any rage (I think) said, "Ma'am, storming out the door is not helping you or your pet any. She has a condition that is a medical emergency, and she needs help. What are we working with financially?"
"I ain't got nuthin' but the $92," she sullenly replied.
"Ma'am, I can't fix it for $92. I can probably fix it for around $175."
She shook her head vigorously and again turned to storm out (her male counterpart has been silent this whole time).
"Ma'am, turn around here, and let me at least give you some advice so your dog doesn't die."
She whipped around with a nasty look on her face but thankfully, she kept her mouth shut.
"You need to keep your pet cool with wet, cool towels and a fan. You need to give her calcium by mouth. Purchase Tums and administer x amount. Take the puppies off of her, so they do not continue to drain her. You'll have to hand raise them. It's 4am, and your vet (I'm pretending she HAD a vet) will be open in about 3.5 hours. Get her there immediately."
She actually muttered "thank you," before storming out.
I love it when people make bad decisions (6 kids by age 26 and not having the money to treat her pet whilst breeding irresponsibly!) and then expect me to fix their problems.
What sucks the most is who really suffers here: the mama dog and the puppies that will inevitably die because these people don't have two brain cells that synapse together.
As she came in, I asked her, "when were her puppies born?"
"Two weeks ago," she replied.
I briefly explained that her dog was exhibiting signs of eclampsia ("milk fever") and that she needed emergency treatment. I explained the exam fee of $92. She glared at me, and said, "I guess that other check will just have to bounce, then."
I should have known what was coming at that point, but I went ahead and took the dog from her and headed to the back. My tech was waiting.
"$250 deposit up front," I said. Eclampsia is pretty easy and cheap to fix (as I've said here before). It's an emergency I have a hard time not treating, even when the owners have "no" money (i.e. refuse to spend it on their pet instead of their cigarettes and cell phones). She disappeared up front while I started getting vitals on the tremoring dog.
All of a sudden, I heard a flat bang and then the unmistakable skitter of a pen across the linoleum. Moments later, my technician reappeared.
"She wants her dog back NOW," she said. "Oh, and she threw the pen across the counter at me."
I marched up front and handed the dog to the owner. "You said it would only be $92," she accused me, as she turned to storm out the front door. "I got 6 kids, and I can't afford no $250-300."
As she's pushing out the door, I seethed inside, but flatly and without any rage (I think) said, "Ma'am, storming out the door is not helping you or your pet any. She has a condition that is a medical emergency, and she needs help. What are we working with financially?"
"I ain't got nuthin' but the $92," she sullenly replied.
"Ma'am, I can't fix it for $92. I can probably fix it for around $175."
She shook her head vigorously and again turned to storm out (her male counterpart has been silent this whole time).
"Ma'am, turn around here, and let me at least give you some advice so your dog doesn't die."
She whipped around with a nasty look on her face but thankfully, she kept her mouth shut.
"You need to keep your pet cool with wet, cool towels and a fan. You need to give her calcium by mouth. Purchase Tums and administer x amount. Take the puppies off of her, so they do not continue to drain her. You'll have to hand raise them. It's 4am, and your vet (I'm pretending she HAD a vet) will be open in about 3.5 hours. Get her there immediately."
She actually muttered "thank you," before storming out.
I love it when people make bad decisions (6 kids by age 26 and not having the money to treat her pet whilst breeding irresponsibly!) and then expect me to fix their problems.
What sucks the most is who really suffers here: the mama dog and the puppies that will inevitably die because these people don't have two brain cells that synapse together.
Thursday, November 11, 2010
A happy story
Instead of one of the myriad "want to make me yank my hair out and simultaneously beat my head against a wall until blood sprays from ears" stories from this week, I'll tell one with a happy ending.
Monday night, my technician handed me a chart. The patient was a larger breed dog (around 60#) with a history of lethargy beginning that morning. She was seen at her veterinarian. He did not notice anything out of the ordinary. Bloodwork was submitted to an outside laboratory, and he discharged the dog (Izzy). Throughout the day, her lethargy progressively worsened, and then she began to breathe hard. It wasn't respiratory distress, just very heavy breathing. She also developed a huge swelling on her neck.
When I examined her, I found a depressed dog with muddy gum color, harsh respiratory sounds at the top of her chest, decreased sounds at the bottom, and a large, soft, fluid-y swelling under her neck. Izzy was a free roamer in the country - running wherever she wanted, no fence. Many things popped into my head, but I couldn't figure out what the swelling under her neck was.
So I went to talk to the owner. It was then that I noticed the name on the chart. It was my realtor! The very one that found us our house. We chatted about Izzy's history, and I recommended repeat bloodwork, then stepped back into the ICU. Then my technician (thank God for great techs!) slapped her hand on the table and said, "I bet I know what that swelling is! I bet it's a hematoma (blood clot) from where they took blood from her jugular this morning." At that moment, the pieces started to fall into place - labored breathing, pale gums, hematoma, and free-roaming.
That equals RAT POISON!
Sure enough, the clotting times were off the chart high. Izzy was bleeding (very mildly at that point) into her chest space and also a little into her lungs. After her fresh frozen plasma transfusion and vitamin K, Izzy was a new dog. She went home with her very grateful mom to hopefully live many, many more days. Her owner told me the next morning that they had scattered rat bait around the barn, and they'd noticed Izzy was pooping green - but they hadn't put two and two together.
Needless to say, they cleaned up all the rat bait, and Izzy will live to fight another day.
Monday night, my technician handed me a chart. The patient was a larger breed dog (around 60#) with a history of lethargy beginning that morning. She was seen at her veterinarian. He did not notice anything out of the ordinary. Bloodwork was submitted to an outside laboratory, and he discharged the dog (Izzy). Throughout the day, her lethargy progressively worsened, and then she began to breathe hard. It wasn't respiratory distress, just very heavy breathing. She also developed a huge swelling on her neck.
When I examined her, I found a depressed dog with muddy gum color, harsh respiratory sounds at the top of her chest, decreased sounds at the bottom, and a large, soft, fluid-y swelling under her neck. Izzy was a free roamer in the country - running wherever she wanted, no fence. Many things popped into my head, but I couldn't figure out what the swelling under her neck was.
So I went to talk to the owner. It was then that I noticed the name on the chart. It was my realtor! The very one that found us our house. We chatted about Izzy's history, and I recommended repeat bloodwork, then stepped back into the ICU. Then my technician (thank God for great techs!) slapped her hand on the table and said, "I bet I know what that swelling is! I bet it's a hematoma (blood clot) from where they took blood from her jugular this morning." At that moment, the pieces started to fall into place - labored breathing, pale gums, hematoma, and free-roaming.
That equals RAT POISON!
Sure enough, the clotting times were off the chart high. Izzy was bleeding (very mildly at that point) into her chest space and also a little into her lungs. After her fresh frozen plasma transfusion and vitamin K, Izzy was a new dog. She went home with her very grateful mom to hopefully live many, many more days. Her owner told me the next morning that they had scattered rat bait around the barn, and they'd noticed Izzy was pooping green - but they hadn't put two and two together.
Needless to say, they cleaned up all the rat bait, and Izzy will live to fight another day.
Wednesday, November 10, 2010
Oh wow...
do I have some funny client stories from my first week back. And by funny, I mean "so depressing it kinda makes me want to hide in a closet for the rest of my life and knit socks." In lieu of that (for now), pictures of Pearl Harbor. It's a graceful, somber memorial. My husband's grandfather (still living at 90 years old) was in the Navy and aboard the USS Raleigh when the attack came. His ship was partially sunk. They suffered casualties but no mortalities. It was an especially meaningful day trip for the both of us, as we both come from military families.
Tuesday, November 9, 2010
AWOL
Sorry, I've been AWOL since I came back from Hawaii. I went straight back to work the day after we returned, slightly jet-lagged, and of course, my presence brought the crazy. It never really slowed down after that. So, I'm very tired and very busy at work.
Some more pictures for your viewing pleasure.
Honolulu as we drive in to the city:
alt=""id="BLOGGER_PHOTO_ID_5537542928409974178" />
Waimea Valley Falls (scene from Lost filmed here)
Me jumping off the big rock at Waimea Bay
Our first sunset, over Hawaii Kai (southeast Oahu)
"The Mokes" - 2 bird island sanctuaries off of Lanikai Beach
Some more pictures for your viewing pleasure.
Honolulu as we drive in to the city:
alt=""id="BLOGGER_PHOTO_ID_5537542928409974178" />Waimea Valley Falls (scene from Lost filmed here)
Me jumping off the big rock at Waimea Bay
Our first sunset, over Hawaii Kai (southeast Oahu)
"The Mokes" - 2 bird island sanctuaries off of Lanikai Beach
Friday, November 5, 2010
Aloha!
Hawaii was beyond anything I could have imagined. A fuller post later, but some pictures today. The highlight of the trip:
We visited a place known locally as "Electric Beach." It is located on the West side of Oahu at the base of an electrical plant. The outflow valve is underwater and pumps a ton of really warm water into the bay. A reef has sprung up along that pathway. If you go early enough in the morning (around 8-9am), spinner dolphins swim offshore. When we arrived, I was a little doubtful. It was sparsely populated, there was only a very small beach, and some very large waves and rocks against which to get dashed. I was a bit intimidated.
I'm not the world's strongest swimmer. But almost immediately, we could see the dolphins flashing into the air and then crashing back into the ocean. They were about 1/2 mile out to sea, in water easily 30-40 feet deep. I was with an experienced snorkeler and water baby whom I trusted completely (my friend Stacie) and 2 ex-lifeguards. I donned my flippers, snorkel, and mask, and prepared for the swim.
It was - bar none - the most amazing experience of my life. While we floated in crystal clear water 35 feet deep, we were surrounded by a pod of dolphins. There were babies and adults both. They clicked and squeaked. It was easy to hear them under the water. They did not seem disturbed at all by our presence, and we drifted with them for well over half an hour. No other snorkelers nearby, no tourists, no yelling, excited kids trying to touch or disturb the dolphins. Just the cool, deep ocean and dolphins all around. The swim (with flippers) was unstrenuous in the calm waters farther out.
Rocks on which to be dashed.
Another amazing experience was Hanauma Bay, a collapsed volcanic crater home to a warm, shallow reef. I wanted more than anything to see a sea turtle or an octopus. I was lucky enough to see BOTH. Going in the off-season is a great idea, as there are so many fewer people. The waters were calm, the animals plentiful. We swam with 2 green sea turtles (no pictures:( and one very curious octopus that darted away and then came back to check us out. He put himself in a hole in the reef, then would poke his head out to check on our whereabouts periodically. He changed colors in a heartbeat (as well as texture), from spiky and brown to match the reef to a brilliant pearl white with rippling grays bars to an unbelievably deep violet. He was magnificent and fascinating and obviously as interested in us as we were in him.
Then there was gorgeous Waimea Bay where the husband and I took the plunge from the famous giant rock (about 2.5 stories) into the warm waters and basked in the sun, stunning Waimea Valley botanical gardens, Waikiki, somber and beautiful Pearl Harbor, and just the entire experience of being saturated in an island lifestyle. I didn't wear makeup once, I let my hair get salty and tangled (it's ridiculously long), and I felt amazing. More to come....
We visited a place known locally as "Electric Beach." It is located on the West side of Oahu at the base of an electrical plant. The outflow valve is underwater and pumps a ton of really warm water into the bay. A reef has sprung up along that pathway. If you go early enough in the morning (around 8-9am), spinner dolphins swim offshore. When we arrived, I was a little doubtful. It was sparsely populated, there was only a very small beach, and some very large waves and rocks against which to get dashed. I was a bit intimidated.
I'm not the world's strongest swimmer. But almost immediately, we could see the dolphins flashing into the air and then crashing back into the ocean. They were about 1/2 mile out to sea, in water easily 30-40 feet deep. I was with an experienced snorkeler and water baby whom I trusted completely (my friend Stacie) and 2 ex-lifeguards. I donned my flippers, snorkel, and mask, and prepared for the swim.
It was - bar none - the most amazing experience of my life. While we floated in crystal clear water 35 feet deep, we were surrounded by a pod of dolphins. There were babies and adults both. They clicked and squeaked. It was easy to hear them under the water. They did not seem disturbed at all by our presence, and we drifted with them for well over half an hour. No other snorkelers nearby, no tourists, no yelling, excited kids trying to touch or disturb the dolphins. Just the cool, deep ocean and dolphins all around. The swim (with flippers) was unstrenuous in the calm waters farther out.
Rocks on which to be dashed.
Another amazing experience was Hanauma Bay, a collapsed volcanic crater home to a warm, shallow reef. I wanted more than anything to see a sea turtle or an octopus. I was lucky enough to see BOTH. Going in the off-season is a great idea, as there are so many fewer people. The waters were calm, the animals plentiful. We swam with 2 green sea turtles (no pictures:( and one very curious octopus that darted away and then came back to check us out. He put himself in a hole in the reef, then would poke his head out to check on our whereabouts periodically. He changed colors in a heartbeat (as well as texture), from spiky and brown to match the reef to a brilliant pearl white with rippling grays bars to an unbelievably deep violet. He was magnificent and fascinating and obviously as interested in us as we were in him.
Then there was gorgeous Waimea Bay where the husband and I took the plunge from the famous giant rock (about 2.5 stories) into the warm waters and basked in the sun, stunning Waimea Valley botanical gardens, Waikiki, somber and beautiful Pearl Harbor, and just the entire experience of being saturated in an island lifestyle. I didn't wear makeup once, I let my hair get salty and tangled (it's ridiculously long), and I felt amazing. More to come....
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