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.

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.

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.

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.

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.  :)

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.

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.