Sunday, November 24, 2013

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.

Tuesday, November 12, 2013

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!

Thursday, November 7, 2013

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.

Thursday, October 31, 2013

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!)

Tuesday, October 29, 2013

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. T
he 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.
 

Tuesday, October 22, 2013

Good help is hard to find

I have the decidedly unpleasurable job of working with someone I actively hate. This is very weird for me. First of all, I generally do not HATE people. Yes, there are people that I like more than I like other people, but usually I like everyone I work with. On rare occasion, I dislike someone I have to work with, and that is of course unfortunate but part of life. These days, well - actually feeling hatred for someone is so disturbing. I pull into the parking lot, see her car, and start bubbling with rage and wondering how I will get through the day. I hope she will fall ill and have to leave. I fantasize about sending her home and just working on my own. It's terrible, just terrible. I don't know what to do with this feeling.

She's not only has a generally unpleasant demeanor (she babytalks constantly, she never shuts up, she has no conception of personal space) but she is ignorant and incompetent and sadly, I am not The Big Boss, so I cannot fire her.

We call her BTT (babytalk tech) for short around here. None of the other docs let her do any patient care while not being directly supervised, none of us let her calculate drug doses, none of us let her administer medications we haven't handed her directly - she can't be trusted to do these things. Despite having to supervise her so heavily and having restricted her duties as much as possible, she still continues to drive me UP THE FUCKING WALL. Ahem. Sorry for the outburst.

So, yeah. In recent past:

A giant-breed dog presented with a laceration of a toepad. My intent was to sedate him, infuse a local anesthetic, & repair it with just two stitches. I asked her to hold off a vein for me and she started to do so but then let go of his leg JUST as I was about to inject, telling me she needed a tourniquet. I felt that a tourniquet was (a) not needed and (b) going to be a problem as she would then need to release it without his leg moving/dislodging my needle, & told her so, but she (in baby talk) told me that her thumb was just getting TOO TIRED and she refused to proceed without the tourniquet, which she was trying to apply as I was sitting there on my haunches in front of the dog telling her to stop it. The dog freaked out because she pinched his skin with the tourniquet and started attacking us, requiring muzzling and then IM sedation with very high doses to overcome his catecholamine surge. So then of course he took forever to recover. I was outraged. Frankly I am still outraged.

A client came in for "I think I pulled my cat's nipple off!" and apparently she did not, in fact, pull the cat's nipple off. I was in my office typing up charts when BTT came in and said "good news! your next patient doesn't need to see you, she thought she pulled off a nipple but it was just some waxy debris stuck to the fur." I said "is that all it was in for? you can send it home if it doesn't need to see me," because I was backed up with my charting anyway. She said "ok" and and walked out. Then she came back THIRTY MINUTES LATER and asked me when I was going in to the exam room to see that patient. The two other staff members and the boss, who had witnessed our previous interaction, were all completely gobsmacked. We thought she had sent that patient home! She denied having said anything about me not having to see it.

We had a Scottie whose calculated dose of dexdomitor was 0.07 ml, and BTT gave her 0.7 ml. As if that isn't bad enough, it was the third time we know if that she was off by a decimal point in that way, but it was the first time she'd actually ADMINISTERED it before being stopped by a supervising doctor. She has also been known to put the wrong size of pills in bottles to go home with patients. Now, with the dexdom overdose, she DID realize AFTER she did it that there was a problem, and the patient was successfully treated and went home none the worse for wear. But these incidents are so disturbing to everyone, yet she has not been fired. It's mindboggling. Meanwhile, she points fingers at everyone else.

One time, a puppy came in for a first visit, whose owner had registered him as being 12 weeks old. Upon review of the paperwork the owner brought, BTT found that the puppy was actually 14 weeks old. She had a huge hissy fit, yelling at our blameless receptionist that she needed to be more careful about putting dates into the record. Of course the receptionist had put in the birthdate the owner had given her. The owner had made the mistake and freely admitted it. BTT ranted and raved over this "dangerous error" for a good hour and a half. It was really unnecessary.

My diagnosis is that this person has a PITF deficiency. But, the boss says, "good help is hard to find," so we're stuck with her. I say, "some kind of help is the kind of help that helping's all about, and some kind of help is the kind of help we all can do without!"