I Have A Curse

Maybe it's "beginner's luck," but my cases all turn into wacky, that-never-happens, no-one-has-seen-anything-like-it sagas. I'm not complaining, but it's uncanny. I've had to research things that the other vets have hardly seen a handful of times in thirty years of practice. I've had straightforward cases develop bizarre crazyland complications. Last year, my boss told me I'd seen more weird stuff in two months than he'd seen in two years.

Here's a selection of the weird and wonderfuls I've seen...

• Great Dane with Lyme disease who came back a week later with a severe immune-mediated vasculitis (his leg was a water balloon).
• The same week, a cat came in for a recent "swollen foot." Sounds like a cat bite abscess, right? Nope. Huge elbow mass full of joint fluid. Maybe a synovial sarcoma?
• Also that week, a young cat brought in because he was having trouble breathing. Turns out he had acute anuric renal failure, for absolutely no reason we could figure out, and didn't respond to treatment. Died that day, nothing to do with the breathing.
• My first month in practice I encountered a dog with megaoesophagus, which is a rare condition.
• My first month, I also prescribed routine ear drops for an ear infection--a situation that happens on an almost daily basis. But this dog went death in both ears immediately after starting the drops. The owners were so mad at me I could barely talk to them. Has never happened before in this practice with any ear medication for any of the other vets.
• My boss saw a cat for a cat bite abscess and I ended up with the recheck the next week on his day off. He assured me it would be routine. Turned out to be in massive acute liver failure and spent the day on oxygen support because it could barely breathe.
• My first blocked bladder cat was a female with five struvite stones at least the size of your thumbnail. My boss has never seen as many large stones in a cat in his whole career.
• I saw a cat with nice owners a few times for small issues, then he came in a month later, on death's door, with a stomach full of blood. He was an indoor, only cat with no medications and no access to anything unsavory that we knew of.
• I had an ongoing saga with a cat that wouldn't really eat for weeks to months for no discernable reason. The owner is a little batty, and wouldn't let us do the full nine yards with regard to treatment, but still cicled around with this cat for ages. Weekly rechecks, repeat blood work and imaging, no response to any medication--and we must have tried the whole pharmacy.

I'm sure many more are on the horizon. They especially like coming in when I'm by myself, like Saturdays or in the evening on my late day. There have been a lot of panic texts to my boss these past six months.

First Bird In-Patient - Patched Up A Macaw

Our first injured bird came in, and it went well! There is a nearby bird rescue, and one of their Military Macaws got attacked by his cage mate. He was missing a piece of his eyelid and all the feathers over his tail, plus had some various cuts and bruises. He was quite gentle to work with, however, and I daringly admitted him to the hospital. Our first avian admit!

I'm not great at wound management in general, even in dogs and cats. I tend to fumble through, with lots of direction from the other vets. For some reason I have a difficult time understanding the concepts, even though wound healing was drilled into me in vet school. Something about making the connection between lecture material and physically working with a wound right the hell in front of me has a hard time inside my brain. So, naturally, our first "sick bird" was a wound. But hey, could have been way worse!

I've read plenty about intranasal sedation, but when I was on Wildbase, I never saw it done. So I cruised VIN, checked my Avian textbooks, picked a dose, and went for it. Boom, midazolam and butorphanol right in the nostrils. No one else had seen it done before, either, so then we stood around with the lights dimmed waiting to see what happened. After about five minutes, we had a pretty snoozy parrot! The other vets were impressed.

I flushed out his wounds, applied some silver sulfadiazine and some Tegaderm, and that was pretty much it. It turned out I couldn't do much with the eyelid, though I wasn't sure until we sedated him (and the owner didn't care about cosmetics). Sent him home on antibiotics and meloxicam, and he's doing great.

Here's his good side.

You Have A Cold? Time For GDV Dog To Come In When You're By Yourself.

Yesterday, when I left the house, I felt normal. By the time I got to work, I had one of those, "Oh, the air is a bit dry" sore throats. Then I proceeded to get sicker by the hour. Since I hadn't been sick in the morning, I wasn't prepared. At home I have a cornucopia of cold and flu remedies, but at work all I had was tea. Lots and lots of tea.

It figures this would happen on my late day, when the clinic closes at 8pm. Things went pretty well, considering. Most of my exams were new pets adopted from the shelter, getting their free exam. I speyed a shelter cat. Dental on a dog that didn't need any extractions. For the evening appointments, one showed up super early, one was just a booster with no exam, and we knocked it out of the park.

Yay, maybe I can get home somewhat early and then take some NyQuil and pass out!

Ten minutes to seven, phone call. Young dog that has been severely vomiting all day. May have eaten sewing fabric or needles. Hmm, doesn't really sound like something that I want to wait overnight.

I knew it was going to be a long haul as soon as they arrived, because this dog was a big labby thing that was going crazy. All over the place, jumping, panting, anxious, wouldn't sit still. There were only three of us in the whole clinic, and one of the technicians is recovering from broken ribs so can't handle any animals. So it was two tiny young women against big anxious dog. When we finally managed to get an xray... Oh shit, that looks like GDV.

I decided to call the emergency clinic to see what they recommended. I had the brilliant plan to email them the xrays. Turns out none of us knew how to actually log in to the email account.

Long story short, it wasn't actually GDV, gave it some meds, and the dog got better overnight. They canceled their recheck appointment today, along with the other... three or so appointments I had. So after the handful of morning appointments, everyone kind of shuffled me out the door to go home and rest.

First Dropped Stump

The surgical emergency every new grad fears.

For the non-vets, a "dropped stump" is when a particular artery isn't well tied off when you let go of it (usually accidentally), so uh, blood starts pouring out of it into the abdomen. Pretty much every vet student's nightmare, and inevitable at some point in your career. I've spent years dreading it, being extra super paranoid in every surgery, and it finally happened in August.

Naturally, it was on a day when I was the only surgeon in. And naturally, they had booked a large, deep-chested dog spey for me. It was like looking down into the grand canyon and trying to work with a grappling hook attached to a helicopter. I managed to get my ligatures on, half-blind and up to my elbows in dog abdomen, and, ironically, I wasn't quite confident in them so I wanted to add a third. Just as I lifted the pedicle up to tie another knot, poof, the pedicle was gone. In my hand, securely in the clamp, were the two original ligatures, nice and secure... And attached to nothing.

Sometimes in these situations, blood starts welling up in the abdomen like someone turned on the tap. Fortunately mine didn't bleed all that much, really. I still had to stand there for ten minutes with a fistfull of swabs pressed into the general area, while one of the other vets drove in to help.

At the discharge, I had to figure out how to explain to the client that surgery wasn't exactly routine, but the problem was resolved. I went with "there was more bleeding than usual." At the recheck a week or so later, she mentioned she'd heard a "sloshing sound" the first night. :S

Considering in the very next surgery I did, a cat spey, the clamp cut clean through the uterus and I had to go fishing for the severed end, I was put off surgery for a little while...

Sure, I'm Sure

I need to be more careful about what I say. I've always known this, but I had a reminder today.

I saw a 9 week old puppy, who had been in a week ago for a UTI. This appointment doubled as her originally scheduled puppy exam and first shots, as well as a recheck for the UTI. I had already made a poor impression on these people, because last week, I was about to send her home on Baytril, when I remembered--whoops, we don't want to give that to a puppy of that age. So I quickly caught them, said, "Wait, I changed my mind, take this antibiotic instead," and tried to explain the brain fart with a tangle of poorly articulated blabbering. Turns out this totally confused them (big surprise), and they'd been giving the cephalexin once a day instead of twice a day.

So anyway, he comes in today, and I had a hard time getting history out of him. I asked how the UTI is going, and if she's having any of the same symptoms. For some reason, this completely baffles him. "Any of the same symptoms???" I could practically see the question marks floating around his head. Since she's a puppy, she's still being housebroken, but eventually I figured out that she stopped squatting repeatedly outside and was now passing normal amounts of urine at a time. He asked about the antibiotics, and I told him to finish it up, at the twice daily dose. He asked me the first time while I was still trying to figure out what was going on--I couldn't tell if we needed to re-treat, or if she was better, or what. He then asked me again after we were finished talking about it, and again after the tech had joined us and helped me give her vaccines.

Afterwards, he complained to the front desk:

Him: Is she new?
Them: Since May.
Him: I asked if I should finish the antibiotics, and she said "Sure." She must be new.

He also added that he usually sees "a man." (My boss)

I actually have no idea what I said the first time. I was too busy trying to get the history out of him. I may have said "Sure," but I don't think I did--then again, I wasn't listening to myself. I do have a habit of agreeing to things when I'm not listening. (I'll be writing in a chart, someone asks me something, I say yes... A minute later think, wait, what? Tell me again, I wasn't listening). But I know FOR SURE, I told him all three times to finish the antibiotic and give it twice daily. The tech told me I definitely, definitively, for surely said "YES FINISH THE ANTIBIOTICS."

I know in my heart of hearts that he will forever remember only the "Sure." I'm now terribly paranoid about what other slip-ups have escaped my mouth. 

Interviewing

Acquiring a job was an interesting venture. I went to a lot of clinics in person to drop off resumes, and joined all the websites (AVMA, AAHA, MVMA, you know, all those four letter things). There were two main categories of people who wanted to hire me.

1. Large "chain" clinics in random states, with a generic email inviting me to fly out across the country to work for them, most likely sent to everybody who sticks a resume up on those sites.

2. Clinics out in the boondocks who can't get anyone to work for them, so are like, "New grad? Sure! Heck, we'd hire a vampire at this point."

There was also the one who didn't read my resume past the first line, and offered me a job as a vet tech.

The fact that I have some avian experience and was interested in seeing exotics made me particularly prized by that second group. Bosses who are like, "I don't know anything about that stuff, but there's an untapped market there, so you'll have tons of business!" My current boss was among those who said he'd buy me anything I need for seeing birds. Sadly, I didn't realise how much you can/should go out of your way if you want your avian practice to be really effective, and the scary thing is, I doubt most of those bosses do either. It's not enough to throw birds into the mix and treat them like cats and dogs.

I ended up interviewing at three places. There were a few others I was in contact with, who bailed on me--and probably a good thing, too, because I heard later that they are awful places for new grads. No support, no time in the day to get things done, yet expected to stay as late as necessary to finish up all paperwork and everything, for no extra pay.

There was a common theme among clinics that a lot of places didn't have much in the way of support staff. The one I'm at now is one of the only clinics that has a technician with each doctor at all times. In fact, it's the only one that had 3 other doctors. Most were one or two doctor practices. Also, most were dungeons. Cramped, cluttered, old buildings in desperate need of a redesign. Workplaces with no real break room, just a shelf with a coffee machine and microwave (where does everyone eat lunch??). Dark treatment areas, tiny surgeries, consult rooms with no logical flow between them, ugly waiting areas. The kind of place that starts out depressing and stressful before you've even said hello to anyone.

One of the places that wanted to hire me actually talked smack about their previous new grad. Apparently they hire new grads all the time, because they can't get anyone else to work for them, being in the middle of absolutely nowhere. And most new grads move on after a year or two, so this was one of their selling points: "We've successfully mentored numerous new graduates." But when I started asking questions about the person who'd left, opening up the position, they had some not so stellar things to say. Essentially how she seemed overly needy, wanting advice on every case, asking too many questions all the time. And I'm thinking... I will be wanting advice on every case and asking questions all the time. Seriously?

Then there's the matter of on call. Clinics in civilised parts of the state are within reasonable distance of a 24-hour emergency facility, so on call has become a thing of the past. Unless your clinic is, you know, in the middle of absolutely nowhere. I would have had a 40 minute commute to that particular clinic, and I was required to be within 20 minutes when on call, so I would have had to stay at the clinic one weekend every month. Then they had the gall to say, "We don't want the on call to be a reason someone declines the job." Well, guess what, I have an offer that's almost exactly the same as yours, with no after hours, and no living at the goddamn clinic. Hate to say it, but that's kind of a big deal.

The job I did get was definitely the best choice. :)

My First Day On The Job Involved A Proptosed Eye

One of the reasons I took the job that I did was that they were interested in hiring a new grad, and willing to give me training wheels for my transition from vet student to actual vet. For my first month, I was never alone in the clinic, so no evenings or weekends, and I was paired with the most experienced senior vet techs. My appointments were all scheduled for 30 minutes instead of twenty, and I was given extra "block off" time for work-ins. My first few days, I didn't have any scheduled appointments at all. I was meant to observe, familiarise myself with where everything is, and maybe jump in on work-ins or walk-ins.

As life would have it, there was a work-in at 8am that first Monday. A dog that had gotten into a fight with its larger friend, and may have gotten a laceration above one eye. "Redness" above the eye, they said. Perfect first case for the new grad, they said.

So in I go and as soon as I lay eyes on the dog, I know exactly what happened, and that I have no idea what to do about it. It wasn't a laceration. It was a proptosed eye.

Small, buggy-eyed dogs like pugs and shih-tzus already have their eyes halfway out of their heads. Therefore, it's pretty easy to pop them the rest of the way out. A solid squeeze or bang on the head could do it. If you catch them straightaway, you can push them right back in. Naturally, this happened the previous afternoon, so the eye had been bulging out exposed to the world for more than 12 hours.

In typical new grad fashion, I gave an excuse to bring the dog out back ("have a look at it under the bright lamp in treatment"), found my boss, and promptly went, "What do I do, what do I do!"

Long story short, we admitted her to the hospital for mini surgery to put the eye back in and suture the eyelids together to hold it. All went well, and I saw her every week for a month or two. The eye retained some function to it and time will tell what happens to it in the long run.

It turns out this was a prelude to the theme of my career. Nothing normal happens to me. It's only the wacky, you-don't-see-that-every-day cases, time and time again.

What It Feels Like Being A New Grad

I think I could be a finalist for "Most Awkward Phone Message Leaver in the World." That, and we could also create a drinking game for every time I say or think "They didn't teach me how to do that in vet school."

Vet school led me to believe advanced orthopaedic and ophthalmic procedures would be a common occurrence, and I would be sending out advanced endocrine panels on a daily basis, and chemotherapy is just another day in the office. Nevermind that I still barely know how to bandage a splint.