A Simple Lack of Respect

A different perspective sent in by an intern - what?  We aren't all perfect?  You don't say....   great job, KittySurg.

 

Hi Readers, KittySurg here. I am writing in hope of raising awareness of another issue I see as a great contributor to the high suicide rate in our field. Indeed, performing 4 euthanasias in one day, dealing with Velcro Martha who needs a video of her cat devouring kibble at 2 am to prove the techs aren’t lying, and finding lung mets in your favorite patient can be extremely stressful, but what sends me over the edge at the end of the day is having to deal with some of my asshole superiors and frankly peers, who are so overconfident as to believe that they are always right.

We are a field packed to the brim with type A self-absorbed individuals striving for perfection. The prevailing proclivities are to criticize oneself or criticize others. There is precious little teamwork going on, and support of each other is something we simply don’t have time for.

In the November 15, JAVMA article, “Finding Calm Amid the Chaos,” the consensus from various studies seems to be that those veterinarians transitioning from training to practice seem to be at the greatest risk of depression and suicidal ideation. Entering a new career is always difficult, but working 80-100 hours a week, never seeing family, and living on the poverty line while interest on student debt accrues, can be hellish. If this is coupled with criticism rather than support, one can reach a tippling point, and believe me, many of us have been dangling over the edge.

The fragility of those navigating their first years in practice is a well know fact in Australia and the Netherlands, both of whom have mentor programs that pair newly graduated veterinarians with more experienced colleagues, who help them negotiate their first years in practice and offer general support and advice. I believe that the AVMA should be arranging the same type of mentorship, given the current struggles amid my generation of veterinarians.

Sure, interns and new doctors make mistakes. Constructive criticism is welcome and helpful. I recall giving long-acting insulin IM rather than SQ. The particular criticalist in charge was firm, but nice about my error, much to my great appreciation. She apparently understood that I wasn’t going to learn any more if I’d been able to see the steam blowing out of her ears.

Obviously, constructive criticism for medical mistakes is not the problem I am trying to address. Let’s get back to the topic of unsupportive asshole superiors…

During the first month of my internship, I made what apparently was an insufferable constellation of blunders: I RSVP’d late to the intern dinner, failed to greet a technician in the hall on my first day, wrote in a record that my patient’s anxiety made it difficult to tell if he was painful, and asked Visiting Southern Surgeon if there was a reason not to use a larger holding pin as I watched his 1.6 mm K wire bend under the stress of an overzealous rotation that probably should have been augmented by a cranial closing wedge osteotomy. These mistakes were deemed so serious that they landed me in the office our Very Blonde and Very Crass Hospital Administrator, who has already told our intern class 10 times that she was Business Woman of The Year in our state (after nominating herself 5 years in a row, a detail which she has selectively omitted every time.) VBVC, with her coral lipstick running several millimeters beyond her lip line, asked me why I couldn’t tell the difference between anxiety and pain. “What the hell did you learn in vet school?” she asked, quizzically. “With all due respect, Ma’am,” I learned that animals do not talk.

When I asked Visiting Southern Surgeon about using a larger holding pin, he put down his instruments, looked me in the eye, and told me to “shuuut up.” Later that night when we were finishing up records, he turned to me and told me interns were to be seen and not heard, and that, in one millions years, no question or comment I had during surgery would prove to be useful or correct. “Ahh’m just tryin’ to help you, girl,” he said, with his condescendingly chummy Alabama drawl.

This surgeon’s assumption that the intern is always wrong, and in fact, to blame, has played out perpetually during my year.

Last week, I saw a patient with vestibular disease and a long-term history of otitis externa. I believed that the otitis was a red herring and that the patient had central signs. The attending, Dr. Perfectly Practical disagreed and spent 5 minutes telling me what an idiot I was for missing the obvious—the patient already had otitis, a source of vestibular insult; why would I look elsewhere for an etiology? I was vindicated and (amazingly enough) apologized to when the MRI revealed a giant cerebellar tumor, but I'd spent the morning feeling useless and ignorant.

Then there was the time when I felt my tiny chihuahua patient with a long-term chronic bleed and resultant regenerative anemia (PCV 18) should remain in hospital. Because the source of his chronic bleed had been “fixed,” the attending, Dr. Holier Than Thou Ain’t Never Been Wrong felt he should go home. Yes, the area had been debrided, I thought, but it hadn’t been closed. Little Rembrandt wasn't clinical for his anemia, but I believed he should be in a place that could provide blood transfusion, should he become clinical. Dr. HTT, in so many words, conveyed to me that I had no clinical judgment whatsoever. Yep, time to go work at Starbucks, or better yet, jump off a cliff, I thought. Starbucks won’t even put a dent in my debt. Sure enough, overnight, the little Chihuahua developed tachycardia and bounding pulses. PCV had dropped even further. HTT never apologized—no surprise there.

The next incident involved "Spikey", a cat with paraparesis and pelvic limb ataxia. Spikey needed an MRI, but our MRI couldn't provide appropriate resolution for a creature as small as a cat, so we gave his owners the option of going a few hours away for a stronger MRI or staying here at the hospital for CT/myelogram. Our neurologist had left the practice, and trying not to lose our neuro clientele, we had been given scripts by our Very Blonde and Very Crass Hospital Administrator in response to client questions. One such script stated that all of our surgeons are proficient in CT, myelogram, MRI, and all neurological conditions. Sure Thing, Blondy.

Of course, in spite of these scripts, our Interviewed in Flip Flops Saturday Surgeon from the Virgin Islands had not yet learned to use CT. He'd been here several months, but couldn’t manage to drag his ass to the hospital on a day off (he has 3 every week) to learn how to operate it. The radiologist (who I actually like and respect) was able to operate it, and was slated to be present on the morning my patient needed the CT. All was a go. No one said anything to the contrary in rounds that morning, and Flip Flops had never said that his morning appointments would preclude fitting this in. He said he might have to call in the head surgeon if he got stuck, but this was a "might," and I'd gotten permission from the owners to do the imaging the following day if things got too booked.

This said, I was quite surprised late that morning to learn that Dr. Flip Flops had decided that CT/myelo was out of the question for several different conflicting reasons provided to me by Dr. HTT and later, Dr. Flip Flops himself. I was now supposed to lie to the client and say we felt the cat needed an MRI. I'd had a decent relationship with the client, but he was incensed when I told him that, out of the blue, we'd decided CT/myelogram was going to be useless. Wooden Q Tip (not to be confused with the plastic, pliable variety), the head surgeon, read my client communication (and from home, nonetheless). He grew frustrated with Dr. Flip Flops, and offered to come in and do the CT/myelo himself. Great! Time for the intern to change the story on the client again. Frankly, I felt the clients should just hit up the MRI at the other hospital and give them the business, because we couldn't get our act together and worse, we had lied about it.

The confusion and frustration led to displacement of blame. Where? To the Scapegoat Intern. Where else? Dr. Flip Flops told Dr. Wooden Q Tip that he'd asked me to arrange for him to be there to help run the CT, etc. etc, and I got an earful from everyone involved. Q Tip screamed at me over the phone, “You and everyone else there are useless; completely useless, “ he said. Flip Flops told me I was a waste of his time, and Very Blonde and Very Crass marched downstairs from her corner office and took the case away from me. “Flip Flops and HTT will be handling the case from here on out, she said.” She was nice about it, so I have reason to believe she saw that I was right, but in a pinch, had to apologize to the clients and blame Scapegoat Intern, who didn't know the ropes; Spikey’s owners later came to visit him in the hospital and looked right through me, as if never having met me. After his CT, Spikey became intractably fractious and impossible to handle. I wished so hard he’d bite the shit out of Drs. Q Tip and Flip Flops, but sadly, the docs never saw the need to actually handle him and give him the chance.

I just finished another 100 hour week, much of which was spent dealing with Velcro Martha, who didn’t believe her cat was eating in our hospital. Three nights ago, I was in the exam room with her, trying to explain every alteration in her cat’s fluid rate and why, if he was fluid-overloaded, we weren’t even bothering to exercise him. Worse, I had to talk over her 100 year-old mother, who was alternately slurping her Ensure, farting, and chanting “necky necky, rubby rubby,” while petting the poor cat, who like me, seemed stifled by Grandma’s fart cloud.

The next morning, on my day off, I got a call from a client and friend who asked me to euthanize her diabetic dog, whose blood glucose had grown increasingly difficult to control. In between sobs, she told me the dog was completely distraught, pawing at the water bowl and vomiting. It was 6:45 am when she called. She said she lived 30 minutes away and that it would take her another 30 mins to get ready and get the dog into the car.

I got to the clinic at 7:45, euthanized the dog, and was feeling sad about the whole thing, but at the same time, I had a moment of feeling useful—a  very short moment. As I was leaving, Patronizing Good Ole Boy ER doc/New Dad approached: “If you meet a client here, you have to be here on time,” he said, sneering. The client had arrived at 7:20 and told Dr. PGOB Daddio that they were supposed to meet me at 6:30. I explained to him that the client was distraught, and had surely had been confused. He rolled his eyes as if to say “whatever, dumb ass”. “Furthermore,” he said, blood pressure should have been taken earlier on your renal failure cat.

I have a surgical internship next year, but unfortunately the ending date of my rotating internship and the starting date of my surgical internship are June 29 and July 1, respectively, and also unfortunately, they are on opposite coasts. Neither program will budge. I can feel it: next year is going to be even better.