An Open Letter to the Next Generation of Vets

 I woke up this morning trying to come up with all of the things I am thankful for this year.   The usual things came to mind - the things I am thankful for every day, like my caring husband, my cute dog, my cool family, the fact that I'm in my 40s and still active and healthy, etc etc.  Like I said,  The Usual.

Then I thought about my profession, and how much I appreciate that I will be working with a new grad soon, mentoring her and helping her find her path in this field.  I am extremely grateful to have had the opportunity over the years to represent the profession in a positive light, and I feel honored to be one of those who will mentor and help a new doctor find her way.

In some ways it's a lot of pressure.  I want to convey positivity and appreciation for the profession without tainting her with my own negativities that I've acquired over the years.  She will figure all of that out on her own, in time.

So I wanted to *sort of* write an open letter to this associate, in hopes that she will read it and share it and take it to heart.  Maybe print it out and stick it on the wall as a reference - a reference as equally important in her career as an Ettinger or a Plumb.

Here goes:


Focus on the animals. They are why you do this. Don't give in to the negativity. Humans are emotionally stunted and project everything onto everyone around them in an attempt to not feel so alone. There are entire professions dedicated to this very topic.  Always remember that, because it puts their craziness into perspective for you.

Find the most emotion-inspiring picture you can find and keep it handy. Sad, gut wrenching, happy or joyful - just find one that you can look at and remember why you do what you do. Stay connected to your humanity and fight the Compassion Fatigue Monster every day. Nothing is more sad than not feeling sadness sometimes. There is something wrong with a doctor who never cries.

 You will defend yourself daily. You will never make it about money, but the clients ALWAYS will make it about money. Stick to your guns. Euth is a viable option and a good one. We can end suffering for those we represent and it is a fair choice even when the owner accuses you of being cruel.  Always remember you are not cruel.  Do not absorb the attacks thrown your way.  They do not define you.  Your actions and your responses define you.

Remember that you will have limitations. You can be as big of a rockstar as you choose to be. Don't feel bad if you settle on being a "country vet" and don't look down on those "country vets" if you decide to specialize. We all have our "specialties" in many ways and no amount of schooling will teach you everything. Having a way with people and being able to communicate effectively is the biggest specialty of all. I don't care how many letters are behind your name, if you suck at simple communications, you are not a good doctor.

 Find humor in your day. Laugh at anal sacs. Keep finding poop and farting funny. Don't mind dog hair in your coffee or cat hair stuck to your face. Invest in lint rollers. They also make good door stops.

 Try to remember that they do feel pain, even those osteosarc dogs who lick your face and wag their tail, all while holding up their diseased leg, while their clueless owner stands by saying, "they aren't in pain". You are trained to know the difference; they are an emotionally stunted human who only sees black and white. You see gray. Every day, you see gray. And always remember that our ability to see gray is what makes us so great at what we do.

Our profession rocks, even when the scum suckers in the profession try to make it not so. (screw you, Andrew Jones and Marty Becker - we are all better than you will ever hope to be)

Stay human. Don't let the grind get you down until you can't get back up. Focus on the puppies and the kittens (and foals and calves for some of you!) that you save, the geriatrics to whom you bring quality of life, and all of those in between who just need preventive care.

Stay as current as you can and keep learning.  An idle brain is a depressed brain.  Go to CE every year without fail.  You will always pick up a pearl.

You are a healer. You may wake up one day not feeling like one, and wonder why you got into this profession in the first place.  But you will find that every day, you do everything in your power to try to heal the sick and speak for those who cannot speak for themselves. When the 1 in 10 walks in and gives you grief, try to reach back in your soul and tell yourself they are suffering in their own way as well, and tell yourself that you are thankful to not be walking in their shoes. You will appreciate the same sentiment some day.

Most importantly, do not let this job take over your life. Enjoy your family and put them first as often as you can. Find hobbies that have nothing to do with veterinary medicine.   Get out in nature. Drink wine. Eat good food. Take care of yourself. Take a walk every day if you can, just to breathe fresh air and get your lymph moving so you can stay healthy. Keep moving forward and supporting this profession and making it better, because at the end of the day, what else can we do?

Always, always, always focus on the positive, even if that means death is the positive.  Sometimes you really do have to change your perspective in order to appreciate the true meaning behind a decision.

And always, always be thankful that it was YOU who got into veterinary school because no matter what, we all should still be very proud of being a member in this tiny profession that still represents so much integrity and honor that we risk financial ruin to pursue it.

Because that is the stuff of which we truly are made.
 
Happy Thanksgiving Everyone,  from the West Coast Office of VBB!  :)

Pot calling kettle, uh...names

The one building is taller, lit by floodlights, signed with massive gaudy multicolored flashing moving lights that glow to the horizon. It cost tens of millions of dollars to build and equip and it is staffed with a large number of cleaning and maintenance workers, many more others whose duty is to ensure the comfort of the people who arrive seeking to win, and a core of well-trained experts who determine in large degree whether these people win, or lose. The building was built with one goal in mind. And it generally succeeds in satisfying this goal.

The second building is not as tall and lacks the floodlights. It is signed with modest informational lighted and arrowed directions that facilitate finding the right doors in the dark. It does not light up the sky. It too cost tens of millions of dollars to build and equip and it is staffed with a large number of cleaning and maintenance workers, many more others whose duty is to ensure the comfort of the people who arrive seeking to win, and a well-trained core of experts who determine in large degree whether these people win, or lose. The building was built with one goal in mind. And it generally succeeds in satisfying this goal.

Many people seek out these two buildings, all with the goal of winning, and the risk of losing, occupying their minds. Each of these people knows there is a degree of chance, a degree of randomness but also some predictability, to whether they will win or lose inside each building. Many hope for luck as they arrive. Others pray for divine intervention. Some think they are preordained to win. Others sense they might lose, but they try not to dwell upon this. But they show in great numbers, because the chance to win, however nearly certain or only a prayer, is a powerful drive.

From these brief descriptions you might conclude that there is considerable similarity between these two buildings, and perhaps even more similarity between the people who built them and manage them. Surely these folks have the same goals if the buildings seem so much the same. Obviously, someone spent the money to build, equip and staff these two buildings. They presumably expect some reward for doing this. I think we can conclude that these would not be reasonable investments if some profit did not flow from the people visiting the two buildings into the hands of the people who work in those two buildings and also into the hands of those who paid to build, equip and staff them.

There is one significant difference between the people who built and manage these two buildings. The first of these groups of people is admired and even celebrated and the people flock to their building wearing smiles, and they mostly leave the building at the end of their stay with a similar smile. They spent some considerable amount of money in that building and thus the building served its purpose for the people who built and manage it. Some leave having won, and most do not. Most lose.

The second group of people is sometimes admired and even celebrated, but is often not. This second group is instead very often a subject of distrust and even scorn. The people who visit the building don't generally arrive wearing smiles, and only some leave with one. The people who visited spent some considerable money in that building, and thus this building also served its purpose to those who invested to build and staff it. Some visiting people leave the building having won, and others have lost.

So again it might seem that these are two nearly identical situations. And to many it might seem that this is so. But one very significant difference does exist. For you see, the first group of people who built and staffed their building fervently hope that the people who visit their building will lose. They structure every single aspect of that building to encourage people to lose as much and as often as possible. This first group of people cares nothing more than for how they can create an environment in which people will lose. And they lie, cheat, and steal to insure that this happens.

The second group of people is subtly different, for they instead do everything in their power to see that the people who visit will win. And they spend very little time plotting how to scam more money from their visitors.

So why does the public in general generally like the first group of people more than the second, and they instead often accuse the second group of the nefarious behaviors?

Well.....in case you haven't guessed, the first group of people built and manage a casino, and the second group of people built and manage a hospital. And the people who like a casino and accuse a hospital of lying, cheating, and stealing.....well, they are a bit unclear on the concept.

I'm going to make a leap of faith here and assume that at least some of you reading this see the truth. And then I'm going to ask you to extend some understanding toward your local veterinary hospital. And when I suggest that I want you to consider the recent 20/20 program in which a known self-serving quack spent considerable effort to discredit the people who built and staff veterinary hospitals, I hope you will realize that we manage them the way we do because we fervently hope that the people who arrive with misgivings will leave after having a win. The ravings of a quack notwithstanding, that is what generally happens in a veterinary hospital.

Who let the crazy in?

Here at the VBB South-Central outpost, we receive a LOT of phone calls. We don't get calls just from our clients and suppliers and colleagues. We also get calls from random strangers, both related and unrelated to veterinary medicine. You know - people looking for free veterinary advice because they have no actual vet they work with, or people wanting to know how late the dry cleaner down the road is open, but the dry cleaner never answers the phone so they are just calling to see if we know their hours. Yeah. Hazard of doing business, I guess.

Anyway, recently we have had two particularly memorable phone calls. One was from a client, and one was not. My ReceptionistBB was kind enough to help me reconstruct them for you here.

<ring, ring>
RBB: VBB South-Central Outpost, how may I help you?
CBB: Hi, this is Ms. Epicure, I'm calling about Sir Pees-A-Lot.
RBB: Oh, hi there! How is Sir P doing today?
CBB: Well, I'd like to come pick up some more antibiotics for him.
RBB: Really? Hmm. It looks like we haven't seen Sir P in almost 3 years. What's going on?
CBB: He has a UTI and I need antibiotics for him.
RBB: I'm pretty sure our doctors will need to see him before they can prescribe. We need to  get an accurate diagnosis.
CBB: Oh, I diagnosed him myself. See, I found this wet spot on my bed, and I wasn't sure what it was, so I tasted it. It was definitely urine with blood in it. So obviously Sir Pees-A-Lot has a UTI.
RBB: Oh, let me put you on hold for a minute & talk to the doctor...
[puts on hold, tells rest of office about this story...calamity ensues...then we all calm down & she gets back on the phone]
RBB: Hi. So sorry but Dr. VBB can't prescribe for a patient we haven't seen in more than a year without getting in trouble with the state board. We'll need to schedule an appointment.
CBB: but I already tasted the urine! You know, that is how they used to diagnose diabetes back in the day after all.
RBB: I understand, but dogs can have bloody urine for lots of reasons. How is Tuesday at 4:30?

I just don't even know what to say about this. Really. I mean - I was just not prepared for this to have actually happened. I am not sure how I will look at this client in the eye ever again, either.

Moving on to our non-client phone call....

<ring ring>
RBB: Hello, VBB South-Central Outpost, how may I help you?
StrangerBehavingBadly: Hi - I have a really important question I could use your help with. It's about my purebred, registered Angolan Swizzle Hound.
RBB: Ok, I'll be right with you, just please hold for a moment [puts on hold]
SBB: [hangs up]
<ring ring>
RBB: Hel-
SBB: Hi it's me again, I don't really have time to hold, I need to know if my purebred registered Angolan Swizzle Hound had sex with our neighbor's dog.
RBB: Sorry?
SBB: How do I know if she had sex with our neighbor's dog? He got into our yard.
RBB: Well, is your dog in heat?
SBB: What does that mean?
RBB: You know - in season? fertile? accepting of males?
SBB: How would I know?
RBB: Well, what makes you think they had sex?
SBB: I saw him in the yard, he got on top of her, and he was on there for a while. But I didn't see his peter out, so, I don't know. But I'm worried they might have had sex.
RBB: Well, I wasn't there, so I really can't say. It sure sounds like they may have. You can bring her in for a checkup if you like.
SBB: Isn't there a rape kit for dogs or something?
RBB: No. Well, when did this occur?
SBB: five days ago.
RBB: OK, well - after five days, we might not find microscopic evidence even if that was something the doctor was going to look for which I would have to ask her anyway. If it was right away, surely we could look at a cytology but after five days, I'd have to check with the doctor.
SBB: Well how do I find out if my dog had sex?
RBB: Would you like to speak to the doctor?
SBB: No, he's probably as useless as you are. [hangs up]

Please share some of your phun phone calls in the comments!

Humility

Came into work today, at the VBB West Coast office.  Just a typical day, but nearing the end of the week and I'm feeling a bit...   tired.

Sometimes the fatigue comes in the form of true sleepiness, like the kind most of us are experiencing right now because of the time change.   Other times it's a different kind of fatigue - the compassion fatigue sort of sleepiness.

So I wasn't really looking forward to the stack of messages on my desk, a few of which were from some very emotional clients who were having great difficulty making important decisions for their pets.  Clients who had to decide "if it was time" or not.

Some of us really understand what it means to sit in a room with a crying client and think to yourself, "I really wish I didn't have to sit here and play psychiatrist and listen to this person cry about how hard it is to make this decision.  Grow up.  Be an adult."  All of us have had those thoughts at one time or another.  We are human, after all.

As much as I wish it wasn't so, this kind of stuff simply wears you down over time.  You HAVE to grow hardened by it or else you'll end up blubbering along with every single client who tries to pull at your heart strings.

Anyway, a particular client didn't leave much of a message other than to say he'd be down later this morning to talk to me about the terrible prognosis given to his beloved pet this week by the internist.  I admit it, I was sort of dreading it.

Client arrives, and my staff puts him into an exam room, and then they warned me, "He's very emotional." 

Sigh.  More emotional parasitism.  Into the room I go.

As soon as he saw me, he burst into tears.  He was really struggling with letting go and knowing when it was truly time to put his dog to sleep.  The dog is dying, no doubt - eaten up with cancer so badly that no amount of surgery or radiation therapy will save him.   The veterinary oncologist simply...  sent them home.

Something happens to me in these exams.  I'm burdened with compassion fatigue on an epic level.  But, occasionally, one still gets to me on the inside.

See, as he was crying and tears were streaming down his face and snot pouring out of his nose, the real truth about why the decision was so hard for him became evident to me.   It wasn't because he loves this dog that much, although he admittedly loves it a lot.  It was because his wife, who had passed away a few years ago, had picked out this dog and gave him his unique name.

It was his last tie to his wife.  I get that.  I get that desperate feeling of not being able to let go of something you love.  I'm certain that the void brought about by those decisions is never filled.  Ever.

Its such a dilemma on my end.  To let myself think about these things can sometimes be gut wrenching but on the other hand, I have to stay tough and hardened or else I would go crazy.

This client asked me how often I do this.  I heard myself tell him "every day".  It made him cry harder and he said he was crying for me because he couldn't do it.  He couldn't face those kinds of emotions every day. 

At the end, he decided he was not strong enough to stay with his beloved dog.  In my detached psyche sort of way, I told him I'd be there, make it peaceful and kind and loving, and I told him I knew his wife would probably be standing right there besides us in spirit, waiting to take their dog with her and then start their wait until he would join them both in spirit as well.

It doesn't matter that I'm an atheist;  it matters that I help end suffering.  That is my job.

And sometimes, I really do wish I wasn't so good at it.   But sometimes I do get the glimmer of humility that comes with truly helping pets and people, a feeling so few really understand at all.

Where is the personal responsibility?

A dog limped into my office the other day and informed me that he'd avulsed his gastrocnemius tendon. Well, ok - he didn't actually SAY it with words, but it was pretty obvious from looking at him. Anyway, his person described the history:

Doctor, last night he was FINE! I let him outside, and he was out there for a while in our fenced-in yard. Nothing can get to him out there. He was out there for a while and then when he came back in, he was like this.

Pretty typical, really. So, I told this dog's person that I'd like him to see a surgeon, as I wouldn't be able to fix this here at VBB Satellite Office. She looked at me, apparently shocked beyond my expectation, and remarked "Well! Someone's going to have to pay for THAT!"

Now, I am not known in my social or professional circles for having any real degree of tact. I try to be sensitive to people's needs, but generally I say it like it is for better or for worse. So I replied "yes! Someone is going to have to pay for that, and I expect that someone will be you!." She was quick to correct me. "Oh no, this wasn't MY fault! I didn't do this to him!" and I explained that I in no way intended to confer blame on her, but simply financial responsibility for her pet. She reiterated that since she wasn't culpable, she was not going to pay, and she would be contacting the breeder because the breeder had never informed her that this type of injury could occur to a dog who was "just out playing in the yard."

I'm pleased to report that, in the end, the dog received the care that he needed. I have no idea who is paying for the care, though.

The World Revolves Around ME.

Sent in by a loyal reader:


After a terribly long day at work last week, I came home for dinner and time with my family.  Helped my son study for a spelling test, read to all of my kids for a bit, and then I finally sat down at 10 pm to speed through my favorite show while my wife finished up in the kitchen.  

For some reason, she decided to check our home phone messages - something we don't do on a regular basis because, well, we just don't.

The last three calls were from a client - a client sitting outside of my clinic, wondering why nobody is there to let her in to get her dogs.  Did I mention she FORGOT to pick them up by closing time?  We closed at 7 and she FORGOT to get them.  

The first message from her was at 7:30 pm.  Did I mention we close at 7 pm?

So I called her at 10 pm and informed her that it was her responsibility to show up on time, before we close, and that no, I would not be meeting her at the clinic right then for her to get her dogs - the dogs she FORGOT at my clinic.  She was angry and amazed that no one simply waited for her to show up.  But I didn't give in.

People seriously know NO boundaries. 


 (Thanks for the entry!  And No, people seriously do not know what "boundary" even means!)

Geeks and Dogs

Seen on FaceBook, presented without comment.

Initial post:

Here's one for you types that dabble in physics: A queen size bed (B) is 4,560 square inches in area. A small dog (D) - we'll call her Nala - comes in at 304 square inches lying down; including tail. So D = B(.066667). But something happens to this area ratio over a given time (T), where T is generally a duration from about 10:00pm to 6:00am: During that time T, the perceived ratio of D to B increases exponentially, peaking at a ratio of D = B(.25) at around 3:00am. Is there some natural phenomenon that explains this? A lesser law of Newton or something?

 Response:

You are missing several factors in this equation. 25 years of private research has also revealed the D can sustain an increase in Mass approximately 4 fold.

After the increase in area and mass, D can also change state to an amorphous semi solid. The state change seems to be associated with planetary, thermal or luminal changes. It is noticed most around sunrise local time.

With the change of state, when the owner of B ("O") attempts to push D out of B, O will notice the changed state, akin to pushing on Jello.

The positive news is that science may have a solution. If O can successfully navigate their way out of B, O can apply substance T to reverse the areal, mass and state changes in D. T is almost always a semi nutritious food based substance.

The resolution is initiated via auditory stimuli to D, such as yelling "Treat" (colloquial term for substance T), or rapid loud movement of a firm container of substance T.   See Pavlov.

Resolution of the changes is immediate. Science has been unable to determine any side effects to the areal or state reversion. Side effects to the mass reversion are common. It is believed that Force (F) is involved. It appears that any gain in mass while on B is immediately converted to Acceleration (A) when substance T is applied. Current research suggested this change follows F=M*A, where F is constant, and decrease in Mass leads to increased A when exiting B, and vice versa. Clearly D is a Force to be reckoned with.