Tuesday, January 17, 2012

A day in the life, with *headdesk*

"Doctor, so glad you're here early! Mrs. Cottonbrain called. Chowderhead is having chemo done at Othervet Fancypants Specialty Center, but she's worried about an unrelated problem and is on her way here. Apparently Chowderhead is having bloody urine and seems really lethargic. Hopefully you can squeeze her in."


You see, Chowderhead's chemotherapeutic regimen is known to cause hemorrhagic cystitis (bloody urine) and lethargy could also be related to chemo. I have no idea why the owner thinks this is unrelated and why she is not contacting the oncology team, but I am going to find out I guess.

First appointment: bandage removal on a patient who had some joint surgery done at Awesome Laparascopic Techniques R Us. Making small talk with client while removing the bandage, I asked how Flounder is adjusting to life in a crate. "Oh, he's not being crated. We don't have a crate. We fenced off the living room so he just roams around in there. He is sometimes jumping up on the sofa though. That's ok, right?"


Cue short discussion about the relative expense of a crate vs a second joint surgery.

Second appointment: new puppy! I love new puppies. This one is from a puppy mill 1500 miles from here in Eastern Flaborgia. The new owner is quite concerned about why the puppy mill "got rid of" this puppy when she was five months old. Does this mean something is wrong with her, she wants to know. Um - well, she's shaped like an ottoman when she's a breed that should be shaped like a hot dog, and her kneecaps don't seem to be attached to anything, but otherwise, hey - she's got a cute face and a pleasant demeanor. Just go with it, mister. Count your blessings.

"Hey doc! Phone call, line 3, it's Dr. SameHandsEveryTime from the emergency clinic!"

Me: Hi, This is Dr. VBB, can I help you?
Dr. S: Hi V, it's me. I saw your patient Doomed over the weekend. You remember her?
Me: Yeah, I think I saw her last week for "looking at me funny" and "not being herself," but nothing concrete on exams and owner declined diagnostics, right?
Dr. S: yeah, that's what the record says. So anyway Doomed showed up here at 3 AM with bloody froth pouring out of her nose. We weren't allowed to do any diagnostics either, though. She died at about 5 AM. I just wanted to let you know her owner said something about "that incompetent VBB" and they definitely blame you for missing this. Sorry. I did tell them it might not have been your fault.
Me: *headdesk*

Next appointment: a rabbit! Not something we see every day, but OK, I can roll with it. Why is it here? Head tilt? Ok, probably some pasteurella here but - um - have you noticed, sir, that this rabbit is dragging itself around by its front legs, and has open sores over the surfaces of the hind legs that are rubbing against the ground? Oh, it's your son's rabbit? I'm not sure how that changes the fact that - oh. Your son is only concerned about the head tilt? *headdesk* again.

Lunch break! I smell pizza! Following my nose to the source of the pizza aroma....a crowd is gathered in exam room two and there are three stacked up pizza boxes. There are a lot of sheepish looking staff members standing around with sauce on their faces. Two boxes of pizza are empty. The remaining half pizza is covered with OLIVES. Ugh. Who had the bright idea to brine & eat those monstrosities anyway? Well. I'll just load up on the chocolate-covered espresso beans a client gave us for Christmas, then.

Oh look, here's Chowderhead. Gosh, I expected her hours ago. Hey, she appears to be in septic shock. You're going to need to transport her to the specialty center, ma'am. No. No we do not have a dog ambulance. Because there is no such -Oh. Fine. Go ahead. Report me to the board. Here is their phone number & email address. But first, take your dog to the specialty center - and keep these fluids running in on the way. Kthxbye.

Hey, what's that noise? Fire engines? Oh, another fire engine just went by. Hey, what's with all these fire engines? Um - do you smell smoke? Someone go look outside & - oh. Hi there Mr. Fireman. What's that? Really? The whole block's being evacuated because of a six-alarm house fire down the road? Sure. No problem. Thanks for the tip.



  1. Really? All that in one day?
    I hope that takes care of a weeks worth. I really, really do.
    And that poor bunny with the rye neck and sore hocks. They probably have it on chicken wire or something else horrible with no place for it to sit on a regular surface. I miss my bunnies.

  2. I having a "broke back" moment after reading about the poor bun.

  3. I can not thank you enough for this blog! I graduated last year and have only been in practicing for 6 months but I'm already about to burn out. Thanks for making me realize it's not just me, everyone has those days and for helping me learn to develop a thicker skin! You are my hero!!!!

  4. I love "only concerned about..." clients. I had a good one today. I saw them a week ago with a vomiting dog. Waiting 20 minutes for bloodwork? Not an option. Allowing me to run the chem panel after they left, and then calling the wife at her job? That's ok. As long as I'm "not wasting her time" by making her wait. Wasting her employer's time is clearly acceptable. So with a cerenia injection and a promise to return if anything in the chem profile needed to be addressed, I let them waltz out the door.

    It turns out that the very impatient clients had a very diabetic dog. Alas, they did not believe me when I called to tell them this. Instead, they told me they would consider treatment, then called one of my co-workers to explain that their dog couldn't possibly be diabetic. I'm not sure whether they thought I wouldn't find out about this, or whether they thought he might have a different interpretation for a blood glucose of 496... He did not, but they were adamant that the dog had NO symptoms of diabetes. So he suggested that we recheck the blood glucose on the following day to confirm.

    Flash forward a week. The dog is vomiting again. What? Cerenia doesn't fix diabetes? INCONCEIVABLE! The wife drops the dog off at the clinic on her way to work. She's not worried about the diabetes, since the dog doesn't really have that. She just concerned about vomiting, and a co-worker told her that cerenia is available in tablet form, so she wants another shot and some tablets.

    Since I can't stab a client over the phone (and I'm calling her at work again), I instead take another stab at explaining diabetes. With words of one syllable. Words like "your" and "dog" and "will" and "die." The owner is convinced the glucose reading was an anomaly. Finally, in despair, I tell the client that I'm re-running her blood panel for free in case there was a lab error. There was not.

    End result: dog is ketotic (and hospitalized on fluids). The owners are paying a lot more to treat the dog than if I'd had my way last week. I like to refer to this as the "defiance tax." Because no, you, as the owner of the dog, do NOT have to listen to me. You CAN actually do what you want, because it IS actually your damn dog. It's just that it costs a lot more in the end.

  5. Very similar to situations when clients bring a half dead dog in and ask "by the way, can you trim his nails?". "Uh, sure, no problem, right after I try to start his heart back up and get some shock fluids running, we'll trim those nails right up for you.." Head, meet desk or wall or whatever I can find in the moment.

  6. Some days go like that..
    1. "I'm so sorry you were put on hold for a couple of minutes by my receptionist who was checking out another client. You say your dog starts shaking when you leave? Sounds like an emergency
    2. "No, I can't give you a discount on doing a dental on your 9 year old poodle because she has heavy tartar again..yes, I realize we did a dental a year and a half ago; you try not brushing your own teeth for a year and a half and see how that works out for you"
    3. "You say the hypoallergenic diet I prescribed last month isn't working? Your kids and husband are feeding her everything and anything so it must be that the food isn't working. I see...Your friend's dog was placed on high doses of steroids and you want that instead because they worked really well for her."
    4. "No, that's not a cyst, those are mammary adenocarcinomas. I can't just drain it and see if it goes away. That other growth? It's a mast cell tumor. Oh, and that abscessed premolar isn't helping things."
    5. "You say that if you had known that there would have been sutures involved in removing the three masses on your boxer you would have never done the surgery? We didn't tell you there would be sutures? Well, on the treatment plan you signed before the surgery the words "suture pack" were on there along with directions that they would need to be removed in 14 days. You didn't read that? Well, not my fault..."
    and on....