Saturday, December 29, 2012

Great Guest Post: From an Intern

So, I’m doing a rotating internship (with mostly emergency responsibility) in a big city.  This might lead you to believe that we see a pretty interesting cross section of the population.  I’m here to tell you that you’re correct. 
Me (seeing a pet for limping): So how long have you had him?
Client: About a month, I guess.
Me: Where did you get him?
Client: From a crackhead, I guess you could say.
Me (pause): So I guess he hasn't had his vaccines, then?
Aside from crazies, this internship has also made me wary of:

1.       Allowing any animal ever to be on a balcony.  Ever.  Dogs and cats, sentient beings though they are, apparently lack the self-preservation instinct necessary to prevent them from launching themselves off a 3rd floor balcony ON THE DAILY.  Regardless of what the general public feels about cats, their balance, and their ability to land on their feet trauma-free, I have euthanized way too many young, otherwise healthy cats to believe that it will prevent them from horrendous injuries.  Many of these cats start their day curiously observing the world from above and end it with a tearful euthanasia after they have broken their back and are unable to use their hind limbs.

2.       Dog parks: I see about 3-5 dogs bitten by other dogs each week.  Most of the time, the owner of the bitten dog is FURIOUS that they have to quarantine their pet for 6 months…in spite of the fact that they would have had a shorter quarantine period to contend with if their dog was up to date on rabies vaccinations OR no quarantine at all if they had obtained the information of the animal (and its owner) that bit their pet.  You get the information of somebody who rear-ended your car: please do the same when your pet is injured by another pet.

3.       Outdoor cats in general: wounds of unknown origin, being hit by a car, or (my favorite) just not noticing that their cat is even mildly ill ill until it crawls half dead to their back porch as a DKA or a saddle thrombus or with a necrotic limb that was probably injured days ago.

Something that has always scared me (and I wish scared more pet owners) is rat poison.  I think my most rodenticide case very poignantly illustrated that owners often feel that “rat poison” or “mouse poison” either isn’t appetizing to their pets or isn’t dangerous to their pets (it's called, moise poison for a reason, right?  WRONG.):

Me: So how did your dog get to the poison? (IE: why was it even around her at all?)

Client: Well I had wrapped it in peanut butter…

Me: (Pause)  Why…what…is there a reason that you did that?

Client: So the rats would like it better.

Me: (Prolonged pause) Just…so you know: rat poison is often pretty tasty to begin with, so you really shouldn’t ever have it anywhere she should get to.  I just wouldn’t have it in the house at all, honestly.

In this particular situation, she felt very strongly that the amount in the estimate was too much to pay for her pet’s care (read: she couldn’t really afford any care at all).  I, on the other hand, felt very strongly that she should not have WRAPPED AN ALREADY APPETIZING TOXIC SUBSTANCE IN SOMETHING THAT NEARLY EVERY DOG LOVES TO EAT.  Fortunately, we were able to make her vomit what looked like the offending substance within about 20 minutes of ingestion, so I’m not sure the dog even absorbed any, but it was (unfortunately) the neurotoxic variety, which always makes me much more nervous than the often easily treated anticoagulant variety.  I ultimately sent her home with a bottle of activated charcoal (after she asked me if there was a “home remedy” she could try instead), and I emphasized that she needed to come back in if she noteiced any strange behavior/seizures/tremoring.  I never heard from her again, so hopefully that means that she did well.  And hopefully her owner will get rid of the rat poison as I reiterated several times that she should do.

Summary: if it’s your fault that your pet had to go to the ER, please don’t get mad at me when I tell you how much the care she needs will cost- especially when I am pretty darn nice about the pretty darn stupid thing that you did.

Thursday, December 20, 2012

whatever bubbles up

Chanukah holiday tips (just save these for next year):

1. No, your cat doesn't know enough not to burn himself on the candles. Also, doesn't know enough not to knock over the chanukkiah. Singed whiskers are not an emergency. Blistered eyelids are an emergency. I'm not sure why clients so often get that backwards.
2. Re: dog, see (1).
3. Fatty food can cause pancreatitis - I'm sure Fluffy DOES love latkes, but don't come crying to me when he has to be in the hospital for a week.
4. Freshly made sufganiyot will be generally well-received by your veterinarian regardless of religious affiliation, btw.

Christmas/winter break tips:

1. Keep pets away from toxic plants.
2. Keep pets away from potentially toxic or obstructive decorations.
3. Yes, even if you think your pet knows better.
4. Boarding is stressful for your pet. If your pet comes home from boarding acting kind of stressed out, this does not mean he was abused in the kennel.
5. There is no vaccine or quarantine practice that is 100% effective at preventing 100% of cases of infectious disease. If your pet comes home from boarding with an infectious disease, that does not mean that the kennel doesn't know what it is doing.
6. If you're giving your vet a fruitcake, please be liberal with the application of alcohol to said fruitcake.

Some random haiku for you:

Anal sac juices
Are the foulest smelling thing

Toenail overgrowth
Pluck that sucker out

That's a nipple, sir.
Yes, male dogs have nipples too.
Don't take off your shirt.

Hairless Sphynx cats
Feel like sweaty penises.
Try to prove me wrong!

December 14th:
Horror. Atrocity. Pain.
Such a tragic waste.

I do hope that last does not seem flip. Fact is, I cannot delve into that topic more than very superficially without completely breaking down. Such a terribly tragic loss for all of those families, and our country, and the world. There really are no words to express the magnitude of the loss or the depth of the grief I feel when I consider it.

And on that note, this particular VBB wishes you a healthy & peaceful year's end, and health & good fortune in the year to come. My colleagues will have to keep you entertained for the next wee bit because I'm GOING ON VACATION!

Tuesday, November 27, 2012

Know When to Shut Up

At the ER this weekend, we had a case with a family involved. There was a mom, and a dad, and a particularly good little boy.

As we were finishing up, I asked the boy how old he was. He proudly held up four fingers. He added "Then I'll be five, then I'll be six,..." etc. When he got to ten or so, I asked him, without thinking, if he could count up to my age.

The lad looked shocked for a moment, then said "NO!"

I should know better by now.

Saturday, November 17, 2012

One lunch special to go please.

They are crawling out of the woodwork today.

My RBB just told me one of our clients phoned and needed to speak to me. Apparently this client was completely irate that when her husband picked up her dog after boarding, the dog was not sent home with a package of our house diet so that she could transition him back to his regular food slowly. No amount of explaining that this was not standard procedure seemed to calm the client down, and the client was apparently insisting on a prescription for the house diet, which the client could take with her elsewhere, because heaven forbid she ever give us one red cent ever again.

I did pick up the phone and call this client, but unfortunately (can you feel the sarcasm??) got voicemail. I left the following message:

Hi, this is Dr. VBB calling about Fluffy. I got a message that you wanted a prescription for our kennel diet. Unfortunately, I can't write a prescription for anything for Fluffy without examining him. We do feed Food X here at VBB Hospital and you are certainly welcome to purchase that from the food vendor of your choice. I wonder if perhaps there was some misunderstanding regarding Fluffy's dietary status, or regarding your request, because no one has ever made this kind of request in the twelve years I've been here at VBB Hospital. Please give me a call back at 1-800-VBB-HOSP if you have additional questions or concerns.

Either the client has no additional questions or concerns, or is not interested in addressing them, or has not gotten the message because we have not heard back.

Wednesday, November 14, 2012

Update - The Notebook

We remember the story about Mr. Sweets and his owner, a very sweet lady who had advanced Alzheimer's disease, who would rush down with Mr. Sweets if he so much as sneezed, right?  That story was written as much about Mr. Z as it was about Mrs. Z.  That sweet man stood by his wife for YEARS with that horrid disease, keeping her safe and warm and comfortable, maneuvering his way around her deteriorating brain and memory in a manner that required so much love and patience that to this day, I stand back in awe of his abilities.

I talked to Mr. Z last month.  Hadn't heard from him in a little while, and of course, because I hadn't seen Mr. Sweets in a while, I became concerned.  So gave him a ring.

"Hello Mr. Z!  How's it hangin'???"  (cause that's how we'd kid around)

"Oh hello doctor!!  Well, I'm doing well.  Mr. Sweets is doing great!  No problems and he has finally lost some weight!"

Uh oh.  Mr. Sweets lost weight.  I knew what that meant instantly.

"How is Mrs. Z?"   I asked.

"Well, Mrs. Z finally passed last month.  She finally let go of that agonizing body of hers and moved on to the other side."

I got a little choked up, but I held it inside so I could maintain the conversation and not show him how... upset...  I really was.

But after a few minutes, I felt relief.  Relief for Mr. Sweets for finally have a shot at having a healthy body weight and for not having to get *another* physical exam for the third time in a day;  relief for Mrs. Z for not suffering any more after years of living with Alzheimer's;   but most of all, I felt relief for Mr. Z.   He sounded....  happy.  He sounded...  free.   He sounded... relieved. 

He told me once how utterly impossible it was to live with your soul mate and watch them slip into the pit of hell with no memory.  He told me how agonizing it was to look at your wife of 50 years and love her and then have her ask, "Who are you again?"

I understood.  I got it.   It's one of those human condition things, where we survive and we go on.  And Mr. Z is going on.  And not one person on this earth could accuse him of not loving Mrs. Z with every ounce of his soul.

Of course I haven't seen Mr. Sweets since, but that's a good thing.  He's been to the vet's office enough times in the last year to last him...  a lifetime.  But I'm sure he feels relieved too, and is now the caretaker of Mr. Z.

One thing bothered me, though.  When I called Mr. Z, he said...."Oh honey, I forgot...  I thought I had called you and let you know...."   (he hadn't called)

Which sent a shiver down my spine because now I'm worried Mr. Z is slipping without Mrs. Z around.

Mr. Sweets has a very big job ahead of him.  It will be my job to make sure he's around to do it.

Friday, November 2, 2012

No Hope for the Human Race

I've been doing this job for 10 years.  I've seen a lot and few things actually shock me anymore.  But occasionally something happens that makes me stare straight ahead for a few minutes, trying to get my brain around what just came out of the mouth of another being that is supposedly a part of my own species.

I wish I could say it's the usual complaint we all hear, when someone pleads ignorance about giving their dog or cat their rabies vaccine.  They either don't know it's the law or they don't know that they or their pet could die from it or that it's a really, really dangerous disease.  I get that kind of stupidity.

But today... today we got a call that has me scratching my head in both absolute confusion and absolute....  what's the word?  Oh yeah... disbelief at how utterly stupid another human can be.

So little Johnny is an 8 month old Yorkie.  His owner scheduled him this week to be neutered, because he was starting to mark her house (read: piss all over everything she owns because he's now a macho little fucker).  We happily obliged and I neutered him yesterday.

This owner called my staff this morning and screamed at them.  SCREAMED at them.  She had a complaint about the procedure and wanted to make sure we knew she had gotten the worst service EVER from us.

From a simple neuter?  Okay, I'll bite...

She went on to explain that WE TOOK HIS TESTICLES!!!  Her dog went INTO my clinic yesterday with two normal balls and went home WITHOUT HIS BALLS.  She was APPALLED.

Imagine the silence she got on the phone as my super intelligent tech tried to process what was being said to her.

She informed us that 20 years ago when she had her other dog neutered, he kept his testicles.  Never in her life has she had a dog have his testicles removed!

Except....  her other dog was my patient, and guess what?  He was a....  neutered male.  His testicles had been removed, too.

So it made me - for a brief moment - think, "Oh great, the VMB is gonna ding me for not explaining that a neuter means taking the balls out."  I worried about that for a brief moment.

Then I thought...  SCREW THAT.  If my job now entails explaining things like THIS to an owner who has owned dogs previously, who CALLED US and scheduled the neuter surgery - then I'm done with this job.  I cannot be responsible for the complete education of the entire public while they hold no responsibility for their own ignorance and stupidity.

There is no hope for the human race.

Sunday, October 21, 2012

A Big Round of Applause!

The VBB Pharmacy post was SO good...  that those of us here at the VBB Round Table were hesitant to post too soon because we didn't want to push it down on the page, but....

We feel we MUST thank our awesome audience for giving us over ONE MILLION VIEWS!  At the risk of showing our cheesy side and quoting Austin Powers, it must be said:  "GROOOOOVY BABY!"

The success of this blog is owed to our large and ever-growing fan base, and we hope to continue to be as creative and - dare I say - un-PC, as we can!  

Please keep up the great following, continue to comment and give us feedback, and as always, have fun and ENJOY!

This blog's for you, baby.  :)

Friday, October 12, 2012

A good dog.

From the VBB Mailbag, a sad story about a good dog. A little advance commentary - I can really already hear the comments on this, before I've even posted. Some readers will say that no dog who bites a child should ever live to tell about it. Some readers will question whether the dog did in fact bite the child (and I don't know, is the answer). Some readers will wonder why Dr. VBB-sympathizer agreed to euthanize an apparently healthy, good dog - and others will jump in and tell those readers she HAD TO DO IT because otherwise she'd get sued if the dog ever bit anyone in the future. Someone will probably call the writer an idiot for removing the muzzle. There are all kinds of angles when it comes to this kind of story and I can argue pretty much every side of something like this. At the end of the day, this is a story about a doctor, who is also a person, who is grieving, and about a dog, who died at the hand of someone who truly cared, because she had no one else in her life who cared enough. Here's the story:

Had a euthanasia come in today. 8 year old chocolate lab/doodle. Allegedly she bit the family kid 10 days ago. Owner comes in, does paperwork, makes payment. We ask if he wants to be present. He says, "Naw.". He goes out to get her. Brings her in, fighting the whole way. Obviously she doesn't want to be here. He pulls her so violently that he chokes her, but she's inside the building. He hands us the leash, kicks the dog in the butt, tells us to muzzle her and turns to leave. I take her back to the treatment room where my co-worker is waiting. Dog fights with all of her 90 pounds to get back to the door she just came in, and her eyes dart around the room looking for the owner who left her there. I pat her. "It's okay Abby" I tell her, but I know it's not okay. She sits on command. She stays on command. She doesn't fight when we muzzle her. I kneel over her to restrain her while my co-worker finds the vein. As the needle finds it's way into the vein, Abby's tail never stops it's constant drumming on the floor, and she leans into me the way my own dog does. I pull her muzzle off as the solution is pushed into her body and tell her, "You're a good dog Abs. And good dogs don't die with a muzzle on", as my tears fall into the fluffy fur of her head. She slumps to the floor. The tail stops drumming. I lean over her and cry, mourning a dog I've only known for 10 minutes. Why do I do this job? So good dogs never have to cross the bridge without knowing someone loves them. I do. And sometimes it's enough. I hope.

Thursday, October 11, 2012

Wasting Time

I learn something every once in a while. Usually from folks wiser or more experienced than me. I’ve been at this work for a while and I’ve picked up some tricks along the way, but my knowledge base always has room for expansion and enrichment. 

So anyway, this friend of mine, a veterinarian of some renown, was once talking about the frustrations of scheduling appointments with clients who just could not manage to show up. Not show up on time, or not even show up late. Nope…Not show up at all. No call. No excuse. Sure as hell no apology. Just don’t show up. Somebody else, another client, might have filled that slot if the doc only knew, but there it goes, forever empty.

Now, if you work for the government, or if you simply work for some other boss you don’t like, an empty appointment slot means you don’t have to work for a bit, and you still get paid, and that’s a fine cup of coffee you enjoyed while you didn’t work. But suppose you own a veterinary practice, and your day is meticulously scheduled to convenience your clients and yourself, and you can maximize the work and the benefit you provide for those clients if there is some semblance of order to the schedule. Since you work for, and thus are paid by those folks who come through the front door, when someone books a piece of your time, an appointment, and they don’t show, you have still invested that time, but that time will be wasted. 

So at the end of the finite day, when your employees are home and enjoying their families, you sit there in your office with the light on, with the medical records and bank balances and that never shrinking stack of bills, and that serious need to pay all those people who work for you for the time they have spent….and there is that piece of time wasted. No choice. You struggle to stretch the smaller piece of money as far as you can. You’ve done it before. You have to.

We are not just about the money in this job, but without enough of it, we go away. For that is a simple reality. It costs a tremendous quantity of money to run a veterinary hospital, generally thousands of dollars a day, every penny of which comes from the people we serve, and all of which must be paid before the owner of the practice sees one red cent. This is the simple reality the owner of every small business faces even before her need for oxygen.

But beyond reality is that nebulous thing we call life. And our life is marked by time, not money. And as my friend taught me, we might make up the money, but we can never make up the time. For the clock only runs in one direction, and it is most unforgiving.

The draft horse in the novel Animal Farm had a simple solution for when not enough was coming in to support his family. He simply vowed to work harder. And that sufficed for a while to keep things going in the book. But when the draft horse finally died on the job, there was no one to take his place. Bad times fell upon his family. And of course, he also was dead.

I’m reminded of this as I choose to work ever longer hours to keep things going during these difficult economic conditions. If I keep this up long enough, I’m eventually gonna be dead. I’m burning time that will never come back, and time is finite.

Suppose someone approached you in your youth with this offer…

I’ve two jobs for you to consider. You must choose between. One you will generally conduct with a passion and with a sense of satisfaction, but it will cost you much of seven days a week. Welcome to the ownership of a veterinary practice. 

The other job will pay you as well, or often much better, and likely will offer that same satisfaction, or more. You will invest only a normal workweek, and you will go outside to play in the evenings after work, on the weekends, and during those vacations. Which would you take? 

Oh, just for jollies… What if you take that first job, and out of sheer self-indulgence you steal one weekend away from your practice every few months to go play with your family, and the people you pledged to serve bitch and whine because you failed them by not being there for them on that one weekend?  

Which job would you take?

Did ya notice the lesson here?...…You can make back the money, sometimes…but you can never get back the time. And Jack may eventually become a dull boy, despite doing the work he loves.

Now let’s throw in one more, ah…variable.

Suppose you took that first job, and just for jollies we’ll say you own a veterinary hospital, and you are a good citizen so you registered to vote. And then the letter arrives because of this registering to vote thing, suggesting you show up for one day of jury duty rather than go to jail for not. So you bite your lip because some time will go away forever while you are at jury duty, and take away with it that day’s earnings intended to pay the bills. Your clients will complain because you are not there to serve them on that day. But what a good citizen you are! And the judge thanks you for your service, and makes you a fine offer…

“How’d ya like to spend, oh say, the month of November playing juror?”

Well heck, yeah. I’d love to. I’m a good citizen and I’d be a good juror, much better than a few of those seedy looking folks lounging around the jury assembly room down to the courthouse who look like they really should instead be sitting up there next to the public defender.

Of course, they won’t let me know if I’ll be serving that whole month until the very last minute, so the notion that I could find a relief doctor to keep my practice open at least part of the month becomes a little, uh, unlikely. But suppose I do luck out and hire a good doctor. I will pay that doctor more than I would make myself doing that same job, and that doc will generate less for my practice than I do.  Then I’d have the bills and the payroll mostly covered. But I’ll pass the whole month with no paycheck for my family. 

Well, tough titty, said the kitty. The judge proclaims this does not constitute a hardship, so don’t bother asking him to change his mind and let me go serve my first master instead of his catch and release fishery. 

And don’t forget the property taxes due in early December. Make that two months with no paycheck. Merry Christmas.

But it gets better if I cannot find a relief doctor. Then I get to eat the whole thing. Tens of thousands to pay the bills and pay my loyal employees, out of my personal savings that don’t really constitute tens of thousands, because my practice will generate no revenue during that time. This is how it will feel when I finally have that heart attack and cannot work for, oh a month. Real sorry about that, goes the judge, but thanks for your service.

Sure, I could call this a vacation from my practice, and just forget any silly notion of taking an actual vacation for some considerable time. Felony trials are hecka fun. Hells bells, I sure never have even considered taking a month long vacation in my adult life, even though I wouldn’t call a real vacation completely lost time. We’ll call the jury trial a government mandated vacation. First time they ever did that for a boss.

 But I might have saved up for an actual vacation, having enough sense not to bankrupt myself just to run off and have some time for my family and myself. After all, you can plan for a vacation.

Oh yeah…and on top of this, my clients will still complain because I’m not there.

Wednesday, October 10, 2012

I'm Tired

Decades in this profession teach many lessons. For instance, I’ve learned that there are two kinds of tired in this business. One version comes from being so busy during your hours in the hospital that you blindly stumble out to the car at the end of a day, pick up a bake at home pizza as you try to remember where you live, cook it up while gulping down one neat bourbon, and then fall asleep in the chair in front of the usual reruns before you finish the third piece. More on this later.

The other kind of tired happens when nothing of consequence happens for days at a time in the hospital, and you wear out the solitaire game on the computer, and thus at the end of the day when you peek at tomorrow’s bank deposit, it laughs at you. And when you sneak up on the bill file and peer inside, it laughs even louder. On these nights you hit every red light, stalled truck, radar trap, and road repair on the way home. When you finally make it to the house, the good bourbon bottle is nearly empty, but the cheap shit will do, and you have one or six, and the usual reruns are on the tube, but nothing in the house will matter. You ain’t gonna sleep that night at all. 

When the economy sucks like this one, those in our profession get to know both versions. There is no rhyme or reason to what comes through the front door, and you simply go with the flow, busy or slow, for the boat has no oars, just like those oarsmen in government who would tell you they can fix this mess. We are utterly at the mercy of what comes through the front door, as are those folks who come in through the front door.

Today was one of those crazy busy, exhausting days.

I fired up the computer when I walked into the hospital at 7:15. The day’s appointments popped up. Two procedures booked for the 10-12 morning slot. A teeth cleaning on a dog belonging to a friend, and a double enucleation, surgical removal of both eyes, on a cranky old Shih Tzu with glaucoma in both eyes, and likely chronic pain. He has been blind for a while, and now I will make him comfortable for the rest of his days.

The rest of the morning was completely booked, seven appointments from 8:15 to 10. I ran through the usual things I must do to prepare for the day. My receptionist arrived in her usual flurry of noise and chaos, setting my stress level alarm off before I even start the day, just before 8. I could hear her talking with someone in the parking lot. That couldn’t be good.

I knew the guy. He has two Dobermans, one an absolute doll, and the other so afraid of her own shadow that she thinks anyone petting her will kill her, so she kills him first. She is a joy to work with in the hospital. Of course he brings in the psycho one. She had been vomiting since one AM, and the puke looked and smelled like poop. Bad sign. Oh, and she had been eating those parts of the kong toy that the other dog chewed off. 

The xrays were classic obstruction of the small bowel. Time for forget everything else and go to surgery. My receptionist went about calling clients and moving their morning appointments to free up the time I would need. We were in surgery shortly after nine. 

The last of the morning’s surgery was done by 12:30. I hit the bank, and the Chinese takeout, and I was back writing up the surgery records by 1:00. The afternoon began at 1:30. Sixteen appointments awaited. I was approaching tired already, and when the “I paid for part of this clinic and I deserve special attention so forget my tomorrow appointment cause I’m here today” walk-in showed up at 2 we tried to find a way to see her, too. I hope she enjoyed the wait, for the courteous folks somehow got seen before this one. 

I did finally see the mouth, and her cat wasn’t all that bad off, and as she was leaving somebody noticed the weird people standing in front of the clinic so I went out to see if any unreasonable crimes were being committed. Introduce the filthy pet owner holding the puppy in a towel in her arms. The guy translating for her, for her English was missing a few pieces, told me her puppy wasn’t eating, was throwing up, and the diarrhea was bloody. Oh, and no, the puppy had not been vaccinated. 

I can describe tired pretty well, but I’m not sure I can describe the sinking feeling this revelation rewarded me.  I’ve watched hundreds of puppies die from parvo during the thirty plus years this disease has existed. Every one died because somebody didn’t vaccinate a puppy. Every freaking one. And they all died horrid deaths.

Personally, I haven’t been hiding the fact that you can vaccinate against this disease. I have no reason to. I thought it was common knowledge. And I’ve tried to get the word out. But some folks are well isolated from common knowledge. 

I had clients waiting patiently to see me. Some were the very folks who moved their appointments that morning so I could save a life. These were clients who try their very best to be good pet owners. I suppose I could screw them over to see this despicable person holding a sick puppy. That’s what the puppy owner would prefer. And she will pay me later… she promises. 

Thirty years of treating parvo in puppies belonging to irresponsible people. I’ve heard this promise before. It’s not worth the paper it is printed upon. When I turn and walk back into the clinic to take care of the nice people, the memory of all those lies, all those thieves, all those lying cheating irresponsible people whose reprehensible behavior killed all those innocent puppies burns in my memory and my gut.

The woman hung around for a while. She walked into the waiting room with the puppy so we had to lock the room and disinfect it….yet again. When she finally left, she swore at us, the evil in her voice, the hatred. But I was serving the people who pay my bills so I can stay open as a veterinary hospital in these difficult times. 

I’m sorry puppy. I’m sorry I can’t fix the mess that horrible person inflicted upon you. But I cannot afford to carry the weight of every irresponsible asshole. There are far too many irresponsible assholes.  I’m barely surviving here at all, and those nice people and their animals need me. 

I left for home at 6:30. Everybody else left when we closed at 5:30. Eleven hours.  And I was tired.

Saturday, October 6, 2012

Yo, Redditors!

Noticed a little uptick in our traffic coming from Reddit, and found Redditor essentialparadoxes had thrown a link into one of her comments there. Or possibly his comments, you never know, although those who claim we lack diversity will say you do know, and that that's a huge problem. Whatever. Although I'd like to point out that I know of at least one North American veterinary school whose class president about 10 years ago was a gay Puerto Rican man. Hard to get a lot more diverse than that really. I've also met a few international Japanese students studying at North American veterinary schools in the past ten years. But I digress. Thanks for the shoutout, intrepid future colleague! Stay golden.

I'll add a breeder story so I can tag this so folks from Reddit find it when they click essentialparadoxes' link.

About 3 or 4 weeks ago a breeder called completely out of the blue wanting to know if she could bring a dog by for a pregnancy check. The receptionist said she'd be glad to book an appointment with Dr. VBB - but then the breeder said she didn't want an appointment. The receptionist was confused and asked the breeder what she wanted, and the breeder said "I just want to drop by and have the doctor palpate and see if she's pregnant." When told that this would require an appointment, the breeder asked "but what if I don't want to pay? I just want to stop by informally, you know?" 

There's a dent in my desk the size of my head from just that ONE phone call, people.

Friday, October 5, 2012

Rabies on the Brain

I’ve got rabies on the brain. Well, not literally, because that would mean I’d probably be dying in intensive care.
Last week (September 28) was World Rabies Day. It is the anniversary of the death of Louis Pasteur (more on him later).
Rabies is virus which causes a virtually 100% fatal neurologic disease in all mammals, including humans. According to “Rabies surveillance in the United States during 2011,” last year rabies was diagnosed in animals in 49 states (not Hawaii). Besides the “usual suspects” of bats, skunks, raccoons, foxes, dogs and cats, it was also diagnosed in cattle, horses, sheep, groundhogs, deer, beavers, otters, javelinas (shaggy piggy creatures), bison and alpaca. Bambi and Thumper could be rabid!
Rabies is spread by the saliva of a rabid animal. When the rabid animal bites a victim, it inoculates the virus into the tissues. Unlike most viruses and bacteria, which spread through the bloodstream, the rabies virus spreads along nerve cells. Depending on how far the bite wound is from the brain, symptoms might not develop for weeks to months to years. A person in the US died last year of rabies that was acquired from a dog in Brazil eight years previous! For eight years, the virus had been lazily moseying along, inexorably crawling up to the brain.
Once the virus hits the brain, bad things happen. Even in the 21st century, over 50,000 people worldwide die of rabies every year. It is a horrible death of alternating periods of lucidity and psychosis, pain, fever, convulsions, hallucinations and hydrophobia (pathologic fear of water).
I recently read Rabid: A Cultural History of the World’s Most Diabolical Virus, by writer Bill Wasik and veterinarian Monica Murphy. It’s a fascinating book, although I guess I might not qualify as a totally objective reviewer since I tend to get a little bit obsessed about public health and infectious diseases.
Wasik and Murphy weave together a history of rabies and civilization. Although many of the scary epidemic infectious diseases of humans, including Ebola, West Nile, SARS, swine flu, and hanta, are zoonotic (transmitted from animals), only rabies was known to be zoonotic before humanity ever considered the existence of bacteria and viruses. Think of bubonic plague (“The Black Death”): people didn’t realize it was caused by a bacterium spread by the bite of a rat flea. But rabies: slobbering psychotic dog bites human, human turns into slobbering psychotic animal. It was obvious even four millennia ago that rabies was transmitted by animals, particularly canines.
The book looks at theories, preventatives and “cures” over the millennia (the most effective preventative prior to vaccination was cauterizing the fresh bite with a red hot poker); history (St. Hubert is the healer of rabies sufferers); mythology (the slaver of Cerberus spreads both rabies and aconite); connections of rabies to werewolf and vampire legends; the handful of documented survivals of rabid humans; weird ideas that people have had to prevent rabies in dogs (one theory suggested rabies spontaneously arose in dogs due to sexual frustration and suggested prevention by creating “doggy bordellos”); rabies in various species (l’enfant du diable = the devil’s child, a skunk); history of canine mass killings in an attempt to stop epidemics; and a recent rabies epidemic on the supposedly rabies-free island of Bali.
The most fascinating chapter explains how Louis Pasteur developed the first rabies vaccine in the late 1800’s. In fifteen years of veterinary practice, I have never seen a case of rabies and hope I never do. Pasteur (who is also the father of pasteurization and food safety) was neither a physician nor a veterinarian, but was a really smart dude who was passionate about human and animal health.
You can’t grow rabies virus in a Petri dish. The only way Pasteur and his colleagues could grow rabies virus was by maintaining rabid animals in the lab, putting themselves at continual risk of gruesome death. At first they allowed a rabid animal to bite another to perpetuate the virus; then they started collecting saliva from slobbering aggressive dogs to inject into other animals. Eventually they hit on dicing up the central nervous system of a rabid rabbit and depositing it directly onto the dura mater of the recipient’s brain. By repeatedly transferring rabies directly from one rabbit’s brain to another they developed a highly virulent strain. The next step was to inactivate the virulent virus to make the vaccine strain, which they did by leaving the rabbit’s spinal cord out to air-dry for a few days. This air-dried infectious bunny brain was then injected as a vaccine: either a pre-exposure vaccine to prevent infection or a post-exposure vaccine to prevent development of symptoms after a bite.
The first human to receive the vaccine was a boy who had been mauled by a rabid dog. Can you imagine the agonizing wait for Pasteur to see if the boy survived or died? (He survived both the bite and the cure.)
We all learned in vet school that rabies is absolutely, guaranteed fatal. But some new research is showing it might not be completely 100% fatal. There was a girl in Wisconsin who survived clinical rabies after a medically-induced coma and months of rehab. And a recent paper was published in The American Journal of Tropical Medicine and Hygiene that looked at humans living in remote areas of Peru where vampire bats are a common carrier of rabies. 11% of the people had rabies neutralizing antibodies; they had not been vaccinated so those antibodies developed after infection with the real, live virus. How come they didn’t die? Has evolution favored people with a more exuberant immune system that can fight off endemic rabies?
However, despite this research, the odds of dying are still very, very high. Make sure your dogs, cats and ferrets are current on their rabies immunizations, and never approach an ill or strangely-behaving bat, skunk, raccoon or fox.

Thursday, October 4, 2012

The Incredible Disciplinary Action

WHOO HOO!!!!!!

The Not So Incredible Dr. Pol is on probation- AS ARE THE OTHER VETS IN HIS PRACTICE!

Check it out:

Brenda Sue Grettenberger, 69-01-007301 05/26/2012
Weidman, MI
Negligence - Incompetence

Eric Mitchell Gaw, D.V.M. 69-01-008005 05/26/2012
Mount Pleasant, MI
Fine Imposed
Violation of General Duty/Negligence

Jan H. Pol, D.V.M.
Weidman, MI
69-01-003494 05/26/2012
Fine Imposed
Negligence - Incompetence

A while back, we informed you in our most popular post ever, gentle reader, that Dr. Pol (go ahead and tweet him about this post!) was practicing substandard medicine. His lack of adherence to basic standards of care when it comes to sterile technique, anesthesia monitoring, pain relief and basic modern medicine has finally been addressed. Not by Big Veterinary, mind you. By some brave soul who complained to his state board about his malpractice.

Kudos, brave soul! THANK YOU!!! And thank you, good people of the Michigan Department of Licensing and Regulatory Affairs Bureau of Health Professions!

And the local vet school, proud MSU, sending students out to ride with him? Shame on you. You knew. You HAD to know. Students talk.

That goes twice for Nat Geo. Your staff was informed of the concerns practitioners had with showing this hack as an exemplar of our profession. Wanna know why the not so incredible Dr Pol was picked as the national role model of our noble calling, gentle reader?
His son was a production assistant. Click that last link & you can find him listed under "meet the vets" for some reason. They say he works in the "entertainment industry." Yeah. So, they needed a vet. Look no further! F for effort on that one, Nat Geo. Maybe you wanna tweet them too & tell them how ashamed they should be for promoting this kind of negligent & incompetent "care" for animals!

Here's another example for you. "Humans try to project their pain onto the animals, but they just don't feel it like we would," said Dr. Jan Pol. I can not believe that in 2012, someone is still saying that out loud.Well, he said it in 2011 I guess. Still.

Next time, email us. We'll fix you up right.

UPDATE: looks like National Geographic is choosing to completely LIE and make the false claim that this is all due to an administrative complaint, rather than due to any actual medical mistakes. Take a look at this article! I'm going to quote from that article:

The Michigan Department of Licensing and Regulatory Affairs ruled that Pol’s failure to accurately read the ultrasound, perform a C-section and to maintain any records on Mocha was evidence of negligence, or failure to exercise due care, including negligent delegation to or supervision of employees. It also found that Pol’s conduct failed to conform to minimal standards of acceptable and prevailing practice for the health profession.

And now I'm going to quote National Geographic:
 The recent fine placed on Dr. Pol is due to an administrative complaint, not malpractice or misdiagnosis. He will regularly see patients and within one month have taken a three-day course, lifting the probation.

I bet poor Mocha and her grieving family would take issue with the classification of this issue as an "administrative complaint."

Monday, October 1, 2012

Meanwhile back at VBB Animal Hospital...

I know we have a loyal technician and assistant following, and goodness knows I wouldn't want to offend them. I'm sure none of YOU, gentle readers, would ever do anything like this, however.

Here at VBB Animal Hospital we often find ourselves running out of things. You know, things like commonly dispensed medications, bandage materials, pill vials - the things we use all the time. Why is this? Well - times are tough all over, and when you order things, you have to pay for them, and when the clients can't or won't pay for anything, it's hard to cover payroll and stay in business and -

You know, this was supposed to be a humor piece, so, let's leave the messy financials out of this one. So, ok. The other day I was slogging along, seeing appointments, having an ok day really, when I was approached by a staff member. "Dr. VBB," she said, holding back a sob, "I have a problem and I don't know how to fix it!"

Now, I try not to jump to conclusions because in my line of work that can get you into big trouble but she did seem really upset and I have to say my adrenals gave a good squeeze right then. "What's the matter?" I asked her.

She held out two pill vials, one in each hand. These, by the way, were the last two pill vials we had in stock that day. "Mr. Fillitnow called and asked for refills for Landshark's medications. I saw that you had okayed two refills each in advance, so I went ahead and filled them. But - I accidentally put the labels on the wrong vials! What do I do now??"

I'll let you think about that for a minute.

What to do, what to do.

Had I been at my desk, I almost certainly would have just *headdesk*ed right then, leaving her standing there, arms outstretched, near tears, and now worried about my mental health. We were standing in the hallway beside our pharmacy however, so I simply took the vials from her, opened one, poured out the pills, looked at her, and asked "do you think you can take it from here?"

Some days I don't know why I even bother chewing through the restraints, people.

Saturday, September 29, 2012

Please don't stand so close to me!

Despite my hardened cynical exterior, deep inside I have the heart of a social butterfly. Really. I enjoy chatting with people, when they aren't being stupid idiots, and the confines of the exam room don't usually provide cause for me to feel like my personal space is being impinged upon.

That said, life is full of exceptions, isn't it?

I wish I could post a sign on my door listing the expectations I have. To gain entry to my exam room, you must be:

1. Fully clothed. If it requires bikini waxing to prevent hair from curling up above your waistband, you are not fully clothed. If I can see your areaolae, you are not fully clothed. If I can describe the fabric and color of your undergarments, you are not fully clothed.

2. Reasonably clean. This isn't to say that I mind good clean DIRT, or anything. Accumulated layers of human sweat and filth that has not been showered off in who knows how long is another thing entirely. If you've been in the garden just prior to your visit, fine. If you've been gardening all summer and you haven't showered since Easter, step off.

3. Hands-off. You must be able to control yourself. If you feel compelled to touch everything within a 4 foot radius, including my vaccine refrigerator, my otoscope cones, my prize bandage scissors, and even my own personal body - you can't come in. Go away.

4. A Pet Owner: At this point in my life, I really do not have time to talk to you unless you have a pet. I do not want to be on TV. I do not want to be in the newspaper. I do not want to do a presentation at your 8-year-old's school. If you are in the pre-purchasing phase and you are serious about finding a vet in advance - ok, yes, I will speak with you. But if you are just here to "interview" me for your own personal benefit, guess what? I am totally not interested.

What are your exam room entry rules??

Thursday, September 27, 2012


On the lighter side, a friend of ours is having a problem in her practice with zombie puppies. She explains:

We had a recent phone call that had me scratching my head.

Mrs Necro Whelper: My dog was pregnant, but she died before the puppies were born. Only one of the puppies survived. I've had him since he was two days old. He's 18 days old now, but his eyes are still not open. Should I be concerned?
Technician: I can't say without seeing the puppy. I would recommend that you bring him in to be examined by the doctor.
Mrs Necro Whelper: Oh, I don't have the funds for that. click
The technician told me about the call. Problem one: WHAT HAPPENED TO THE BITCH? Seems like important background info! Problem two: if it was the caller's bitch, how is it that she has only had the surviving puppy since he was two days old? Who had him when he was one day old?? Was he BORN two days old? Obviously the only rational explanation for a 2 day old puppy being born from a dead dog: zombie puppy. The technician and I agreed that neither of us were experienced enough with zombie puppies to know when they open their eyes.

Veterinary Un and Underemployment Post

Yes, we are harping on this one.  It sticks close to home and for every vet out there that is looking for a job or struggling to keep their doors open, this is our reality.  Working for Banfield does not cut it.  Have I mentioned how each time I did relief for them, it took threats of calling an attorney to get paid?  I mean, in some cases, it took upwards of 6 weeks.  And even when I was employed by a BF "owned" by a private vet....that took me telling him he needed to write me a personal check to finally get paid.  And that is just the money thing, not the severely limited pharmacy they stock, the cook book medicine, the hard sell, the high turn over rate...etc.  I have worked in mixed animal practice, taking my own overnight call by myself, work as a GP in several practices (could only find part time, so I had to cobble together jobs), worked full time in a small emergency clinic (getting paid $30,000 less than my male counterpart even when I out produced him every freaking month), worked in a large referral/critical care place....worked all sorts of jobs.  And in my 10 years of practice, things have become worse.  Working relief, I can plainly tell you that many of the practices that are needing vets are just not good.  As in mixing steroids up with vaccines....leaving vaccines out every day.  Thinking that every cat that has urinary tract signs has an infection (ack!!!).  The good ones have little turn over.  It is like that neighborhood that everyone wants to move into, but you have to wait until someone dies to do it.  The good practices have a steady, unchanging vet staff.  Once you find that good job and that good job finds a good associate, they stick together like glue.  And the economy is slowly, slowly recovering.  However, this does not mean that the practices can grow.  In fact, many owners are letting their part time people go, so they can take the extra hours and keep their income the same.  So, this information was compiled for your perusal:

2012 JAVMA Senior Survey summary

Journal of the American Veterinary Medical Association
October 1, 2012, Vol. 241, No. 7, Pages 890-894 doi: 10.2460/javma.241.7.890
Employment, starting salaries, and educational indebtedness of year-2012 graduates of US veterinary medical colleges Allison J. Shepherd, MBA; Laura Pikel, BS

Survey offered to 2686 (entire US CVM senior population).
2502 responded.
2501 provided debt data.
2410 looked for paying work.
1272 provided salary data.

43 took a job in public practice.
547 got a job in private practice, down 17% from 2011
-49 in food animal, down 14%
-112 in mixed, down 20.6%
-3 in equine, down 91.9%
-362 in companion animal, down 14%
727 went to advanced education (internship/residency/dual degree), down 5.7% from 2011
1093 were at odd ends.

590/2410 makes an effective employment rate of 24.5%

89.2% (2232) had debt.
92% of debt was from vet school.
Mean debt was $151,162, up 6.4% from 2011
22% had debt > $200,000

$65,998 was the mean starting salary in private practice, down 1.0% from 2011
$29,628 for those in advanced education; up 1.8% from 2011

For context, 4729 took the NAVLE, 3879 passed
4118 takers and 3653 passers were from accredited schools
as there are 2686 US seniors, 4118-2686= 1432 foreign accredited enrollment

Yes, low unemployment of vets?  I don't believe the numbers bear that out.  Grim picture for everyone that wants to be a vet?  Yes.  Down right horrifying for those about to graduate with mountains of debt and few prospects?  You bet your sweet bibby.  Unless you have a boat load of money and a sure job once you graduate, run away.  Shortly, with all of the new openings, the general IQ and scores required to get into vet school are going to go down.  It will be a luxury career for someone that is a second income to a partner.  Is that who you want seeing your pet?  When I got into vet school, there were 60 spots for 600 applicants.  If they widen that pool, does that mean that the average VCAT/GRE score and GPA goes down.  I think so.   Think long and hard AVMA, vet schools,  and large industry.  The veterinary population is begging you to sit up, take notice, and do freaking SOMETHING about this mess YOU have created.

Tuesday, September 25, 2012

Yo, Irreverent Vet! Over here!!!

Dude. I don't know who you are, but I just read your article over on and I'm trembling with rage. So, I'm going to go through it point by point, if you don't mind - seems your blog doesn't really have any comment mechanism I can find so this seemed most efficient.

Your list of things that "Veterinarians Don't Want You to Know," with VBB commentary:

1. A Veterinary Hospital is a Small Business: Duh. Of course it is a small business. Unless, of course, it is a big business because it's one of those megacorporate monstrosities. But I digress. Most privately owned veterinary hospitals are small businesses. This isn't a secret. Most people of normal intelligence are fully aware of this fact. I know no veterinary practice owners who are trying to hide this. Do you?

2. There is a High Profit Margin on Vaccines: again not a secret. I've told people how much our vaccines cost. I've also explained some of the other points you bring up. People can decide what to do. I have never had a person refuse a vaccine based on our markup after I've explained what our markup actually includes.

3. They Want to Sell You Preventative Medication: Well, maybe they do and maybe they don't. Unlike some folks, I wouldn't deign to speak for all vets, but I personally would just as soon do away with the pharmacy biz. It's just that my clients find it a convenience, and if I don't carry these things, they get annoyed (heaven knows we get a ton of complaints if we are out of stock of something!). I'm sure some vets like to keep this business in-house, and that's fine too, but don't tar us all with the same brush, dude.

4. Vaccines Can Be Dangerous: Hello! McFly! Are you actually trying to hide this from your clients? Do you actually know vets who fail to disclose the potential risks associated with vaccines? What kind of scary-ass clowns came to your party? Oh. Oops. Sorry, got carried away there. But seriously - no. I refuse to believe that my colleagues do not disclose that vaccines can have adverse effects, and allow their clients to engage in informed consent. I am completely insulted that you disagree.

5. There is No One in Our Hospital Monitoring Pets at Night: Again with the failure to disclose! Seriously? I find myself fighting with clients who want me to admit their pets to our day practice, literally yelling "BUT WE HAVE NO ONE HERE TO MONITOR YOUR PET AT NIGHT!" and they still want to have the pet admitted. I certainly would never in a hundred and fifty billion years consider admitting a pet and keeping the unmonitored overnight status on the downlow. Where do you practice anyway, that you think this is normal behavior?? Are you in Dr. Pol's neighborhood or something?

6. Vaccine Recommendations Have Changed: ok, at least you say "some" vets are still giving annual vaccines instead of longer vaccine intervals but again - this is not a thing that "Veterinarians Don't Want You to Know!" You make it sound like there is some big conspiracy and that most vets are hiding these facts from their clients! 

7. Vets Often Don't Agree With Breeders: I'm gobsmacked. You seriously think that vets do not want their clients to know that we often disagree with breeders? I would like to see a show of hands from the readership... who here finds him or herself telling a client that the breeder is wrong at least once a day?? I know I do. 

8. There are Some Things Some Vets are Better at Than Others: Were you running out of things for your list? This is just silly. No one individual is equally good at absolutely everything he or she does, and only a complete blithering idiot of a client is going to assume that he or she is. This is not a secret. 

9. You Have Referral Options - I guess maybe there are some vets who hesitate to offer referral, as you say. I'm not one of them but whatever. I'll give you this one. 

10. I'm not that Familiar or Fond of Alternative Medicine: Er - it's true I've never told a client your opinion of alternative medicine. But, they will get an earful of mine - which is essentially "show me the research, if there isn't any and it seems harmless fine, if there is some and it shows efficacy, fine, otherwise, no, stay away."

11. Most Vets in General Practice are "GP's" : Are you kidding? I am starting to wonder if you have a different way of defining 'don't want you to know' than I do. Like the many colleagues I speak to on a daily basis, I am frequently telling clients that I am a GP, and that I would really prefer to consult a specialist. Most of the time they reply "oh Dr. VBB - we really only trust YOU." To which I reply "well, if you trust me, take my advice and see a specialist!" to which they reply "oh no, we could never let any other doctor see Fluffy." *headdesk*

12. Vets Have a Low Tolerance For Aggression: Funny you should bring this up. This week I have told two puppy owners that their new puppies showed unacceptable amounts of aggression to me and that they need behavioral consults. My clients are well aware that aggression is not amusing or acceptable in my exam room. I don't jump to euthanasia as a first line of treatment for aggression, but I definitely have it on my list of treatment options, and if dedicated behavioral interventions fail or are refused, better to kill the dog than the dog kills a person. And I'm not afraid of using muzzles or chemical restraint if necessary. This is all explained clearly up front. No one who has been to VBB central with an aggressive dog comes away misunderstanding this. 

13. Vets Get Attached: Not sure why this is even on your list when you state right there that we sometimes cry. Hard to be keeping it secret when you're crying in the exam room with your client, really. But, I don't know any vets who think their clients shouldn't know how much they (the vets) care about the client's pets. Why would we not want people to know this?

14. Vets Have Bad Days Too: This is kind of right up there with number 11 and number 8 and number 1 as not really something that a normal person of average or better intelligence would not know, and not something that anyone is actively trying to keep secret from his or her clients. Whatever.

15. Cats May be Happier as Indoor/Outdoor Cats: OK, you got me! I do know some vets who would never ever be willing to state that it's ok to let your cat outdoors due to the associated risks. Good work, Irreverent Vet! Now the people know.

16. Your Dog Doesn't Need Vitamins: again, not a secret, not something anyone I know is hiding from people, actually something I tell people all the time and the people choose not to believe. 

17. Not all Foods Are Created Equal: also not sure why this is something you say vets don't want people to know....just seems like list filler. 

18. All Drugs Have Side Effects: see item 4. OF COURSE this is disclosed! 

19. If Your Dog Acts Aggressive We Muzzle: See item 12....

20. Even if Your Dog is Really Bad They May Minimize It: so you see a lot of vets shooting themselves in the foot this way? I don't. I just tell people "your dog's behavior is not acceptable" and then explain why and what needs to be done. Seems many of the vets I speak with regularly do the same....

21. No House Calls: how is this a secret? Obviously if people call and ask for a house call and that's not a service you provide, you tell them, right? How is this something we don't want people to know? Are you saying we just want people to go around assuming if they call us we'll drop everything and run over? Why would we want that? It would just end up in disappointment and anger. 

22. Many Pets Do Better When You Aren't Around: again, not something we don't want owners to know. This is something I tell people All. The. Freakin'. Time.

23. We are Often People People: Not touching this with a ten foot rabies pole :)

24. Vets Hate Talking About Money: ok this is a true statement, but I wouldn't say it is something we don't want people to know. 

25. Vets Aren't Always Right: Sigh. Again with the statements from the Department of Obvious Facts. See #1, #14.... Also not a secret.

26. Pets Can Change: again a true statement, again something I find myself explaining OVER and OVER to clients who JUST DON'T GET IT. So - I'd call this something vets DO want you to know, not something vets do NOT want you to know. Did you get your columns mixed up?

27: Vets are Not Nutritionists: well, some are. The GPs aren't, though. That's true. This is no secret in my practice, but I don't discuss it with a lot of other vets so couldn't say what is generally done. In my practice, I will offer to help with basic dietary stuff, and have sometimes consulted a nutritionist for assistance (at the school where I trained), and have made referrals to nutritionists. Tell me more about how the vets you know keep this hidden from their clients, though! Sounds like a great story hiding behind this.

OK, well - this is all I have to say. Feel free to explain yourself in the comments!

Monday, September 24, 2012

The Fractional Man

It was a dark and snowy night. That's quite rare in south Louisiana. And I was on duty.

Here, we consider snow like having a hurricane during an earthquake during a plague outbreak. No one was moving about that night. I did what any sensible ER type would do. I went for a nap.

I was awakened about 2 AM by the receptionist, saying "We've got a walk-in". Consciousness returned, and I went in. It's amazing how much you can see in the first seconds of an exam.

There, swaying slightly, stood a rather disheveled client. On his hip was a revolver. As a shooter, I notice such things. The revolver had rust and was in a very cheap holster. It was the sort of holster you'd see sold for a dollar on the junk table at a gun show. He also had a badge that said "Special Officer", also dollar gun show type thing.

As soon as I entered he started talking, rambling slurred words that only a drunk can do. He told me he was a US Marshall, in some detail. Look, I know Federal Marshalls socially and as clients. They are well groomed in public, not drunk. They hadn't carried revolvers in a generation. And I've never met a Fed, ever, who's sidearm was rusty.

So drunk? Check. Armed? Check. Liar? Check. I've handled drunks and don't mind guns. But combined they are dangerous. Add in liar, and I wanted him GONE. I was getting pissed.

It took several tries to divert him from the David Koresh ramblings. (The Waco standoff was in progress.) When I asked about why his dog was there, I got silence or "umms". To this day, I don't know why the dog was there. To speed things up, I tried asking multiple choice questions. Whatever I asked he always picked the "B" answer. On physical, the dog looked fine. I think I gave some pen and sent him out as fast as I could.

As I said, I was annoyed. I do not like people impersonating Federal agents. I decided to act.

I called the US Marshall's office and asked to speak to the duty officer. I told him I'd had a client impersonating one of their people. The agent said that was a serious allegation, and asked how I knew. I described the inebriation and dress, and the officer said it was possible that he was not a Fed. When I mentioned the rusty revolver, he said, "Nope, that's DEFINITELY not one of ours. I think we'd like to have a chat with him. Do you have any information on him?" Sure, I got the client info sheet, and gave the officer the client's name. Then we got to the address.

I had not looked at the address until then. "Holy crap!" I said. The duty officer asked what was wrong. I caught my breath. "Let me explain to you that I am not the drunk here. I'll be happy to hand you a copy of this or fax it to you. But I am not making this up.", I said. "Sir what are you talking about?" "It's his address. It's PO Box 0423 1/4". No that is not a typo. The drunk wrote down box 0423 and a quarter. The officer said "Sir? Are you kidding?"

We faxed the sheet. When he got it, the officer said, "Holy crap, you were telling the truth!" I asked what next. The officer promised that they would find the client, and he promised that if I ever saw him again, he would not be drunk, nor armed, and that he would never, ever claim to be a Marshall again.

That suited me. I went back to bed. But to this day, I still wonder what sort of conversation the man with the fractional address had with the real Marshalls.