Wednesday, September 28, 2016

Enough

I'm back...

After a year of amazing/exhausting internship (aka indentured servitude) and several years at a soul-sucking corporate veterinary medicine gig, I can no longer ignore my muse. My stress levels have grown past my level of comfort with self-medication so I have returned to the outlet that has been my escape since childhood. I always knew I would be a writer, I just used to have the far-fetched idea I'd make my living at it; now I think perhaps it is better left as an outlet.

Corporate veterinary medicine is not evil. I appreciate the work, and I appreciate the experience it gave me, and the ability to pay my bills while I found the next step. What I am not proud of is the person it turned me into. I became negative. Angry. Awful. I let the people around me dictate my mood. When I was working with the "good" crew it was even fun at times. When I was stuck with the "bad" crew I became the worst among them. My close friends knew some of my co-workers only by the derogatory nicknames I had given them in my mind. I was that person. It was not a good fit. I'm not saying the criticism I delivered didn't have a solid, factual base; but it was administered in the worst way possible. I was tearing down those around me, and destroying myself in the process.

Somehow, God met me in my dark place and steered me to the next stop on my path. I am now a truly mixed-animal practitioner. It isn't the dream, but it's a pretty good reality most days. My corporate small animal experience has given me enough background to hold my own with the pets, and I'm building the large animal side as quickly as I can. It might even be the new dream.

No veterinary reality is without its trying times, however. Some days those trials come in the form of animals with problems I can't fix. Lately the hurdles have been financial, it seems. Veterinarians as a whole are generous to a fault and I definitely fall in to the trap of "They don't have much money so I'll help them out by not charging the full price for this exam, or slipping an extra treatment in for free" or "It's not economically feasible to keep a calf on ICU rates, so I'll just charge regular hospitalization even though I'm coming up to work on him every 2-3 hours round the clock" more often than I should. I am glad that I don't own the practice, or I would have a harder time holding my ground. I don't mind doing the occasional favor, but I won't steal from my employer.  Emergencies are a whole new challenge, because I don't get paid my cut of the emergency until the invoice is paid in full. I have a file of unpaid invoices dating back to my first week on call. Some of those fees I will never see. I'm not starving, but between paying student loans, paying a mortgage, and renovating/repairing a 50-year-old house I would definitely like to get paid what I'm due for a) getting a veterinary medical degree and license to practice, b) being available to animal owners in need at any hour of the day or night for 50% of my life, and c) leaving my friends, family, and animals to shift for themselves or wait for my return when I get a call that requires emergency treatment.  I actually declined an emergency call recently because the client had a drastically overdue balance owed and the situation was not yet emergent (i.e. no animal suffering). One part of me felt like a cold, greedy bastard. The other part was elated that I had the intestinal fortitude to say no. It's the sad reality of our business. And yes, veterinary medicine is a business. My employer's outstanding accounts receivable would pay my salary for the year and buy the clinic a new radiograph system, which we sorely need. In another situation, I saw a pet whose situation was emergent, after hours, and required calling in myself and one of our wonderful technicians, who also have families and responsibilities at home. We assessed the animal, I discussed the condition, diagnostic next steps, and possible outcomes with the owner. I had already given them a cost estimate for the emergency evaluation. After deciding that the animal's condition was too dire and suffering was likely, the client requested euthanasia. I comforted the pet and owner to the best of my ability, ended the animal's suffering, and the client gathered the pet and essentially sprinted for the door. I'll sleep tonight knowing that the pet isn't in pain, and that only a sucker would bet on ever seeing a dime on that invoice. They won't take our phone calls. This is actually the second "euthanize and dash" I've administered. They'll linger in my "unpaid ER invoice" file gathering dust.  As long as we have enough good clients to keep the doors open, this will continue to happen. I've made my peace with that. This is only one aspect that I believe contributes to the high suicide rate among veterinarians. You can only give of yourself so much without compensation before you lose your faith...in people, in karma, in God. For tonight I have good beer, a puppy who slept in my arms at work today, and a dog who chases the stream of water from a hose with an intensity and joy I can only aspire to in my daily life. For tonight, that is enough.

Monday, March 4, 2013

I Love Making (Horse) Babies

Confession time...I am a repro nerd.  I've been in the closet for four or five years now, but really, I haven't been that deep.  And I've had the door open.  And a light on, even if it was just a bare bulb with a pull chain.  Now that I'm back on a theriogenology rotation, I feel the repro nerd bubbling back to the surface, giddy with release.  I feel I've done a fairly good job of concealing her, as evidenced by the fact that just today one of my classmates confided in me that she finds repro people strange.  Poor girl, she doesn't realize that I'm ONE OF THEM!!!  (BWAHAHAHAHAHAAAAA!!!) 

I used to think I wanted to be a horse trainer.  It was always kind of a long shot, I was never the most confident rider, but at the time I didn't know what else I could be where I could get payed to play with horses.  I figured that with determination and hard work, I could make my way into the training world and carve out a living.  Then I realized that people were willing to pay me to ride some really crappy horses.  I mean absolutely useless creatures.  Even if I channeled Monty Roberts and rode my ass off, these horses would barely rise to mediocre on their best day; bless their hearts, they just didn't have it in them.  I also had the opportunity to ride some very nice, average, competent animals, who kept me from giving up on the industry completely.  Then, I got on a few really trained, talented individuals (trained by real trainers).  This was the real wake-up call.  I knew, no matter how hard I worked, I would never be more than adequate as a trainer; plus, I would have to ride a generous share of Alpo's and Elmer's to get the bills paid.  During this time, serendipity led me to awareness of the repro side of the industry, where I knew I had the natural talent and learning potential to rise above mediocrity.  How I got from there to here is a long story, and for another day...or perhaps best left untold...but I digress.

After mild consideration, and ingestion of a higher-than-suggested dose of NyQuil that I'm waiting to put me into a coma since I can't sleep without coughing up a lung, I assembled the following reasons why theriogenology is sort of awesome:

1. Penis jokes.  They really never get old.
2. Really cool tech toys.  I used to drool over the ALOKA 550.  In my heart, it will always have a special place, but, fickle me, I am now lusting after the sleek, sexy, ultra-portable, bad-ass-display-having SonoVet models.  Also, where else can you have a $50K machine that boasts "Sperm Vision"?
3. Foals.  I'm not such a fan of human babies, but give me something that stands and nurses within the first hour with no outside help?  I'm a cooing, cuddling, baby-talking mess.  I love watching my "kids" grow up, and several of them have gone on to do great things.  That weanling that sold for nearly a million dollars?  Yeah, she tried to paw me in the face when she was a day old.  Oh, you trained the futurity champion?  Well, if I hadn't been there to pull the amniotic sac off his nose, he probably wouldn't have lived long enough for you to ride him.  What can I say, I'm proud of my babies.
4. Getting to say and do things that make my friends embarrassed to be seen with me.  OK, this is sort of a re-hash of the penis joke thing.
5. Where else would I get to stick my arm into the rectum of something that's won more money in the show pen than I have taken out in student loans?  (And I've got a LOT of student loans...)
6. Hanging out with other repro nerds.  We're really harmless, we just smell funny and have a habit of saying awkward things.

There are more, but the NyQuil is kicking in and I'm afraid of what my inner repro nerd might say.

Saturday, February 2, 2013

Lessons from the Working Pens

In the midst of all the crazy that marks the everyday life of a vet student, one subject that has come up repeatedly is livestock handling, specifically horses and cattle.  Though I admit that handling skills will make the treatment of any animal easier, from a simple logistical standpoint, it is easier to force a 20-lb dog to cooperate than a 1200-lb horse.  Even a six weight Brahman heifer can effectively shut down an entire operation simply by sulling up and laying down in an alley.  Short of strapping her to a tractor, there isn't anything you can do to force her to go along with the process, and that is usually a low-yield procedure for all involved.

A number of factors make it difficult for veterinary students to gain good livestock handling skills.  First, more students are from an urban background, and even if they have experience with large livestock, this experience is usually limited.  Second, the sheer amount of information we are expected to absorb in four years makes it impossible to include an in-depth study and practice of livestock handling.  The few lab experiences that school does provide, in my view, do more to make the situation worse on some levels.  Handling school-owned teaching animals is a whole different game than handling "real" livestock, and can impart a false confidence that will lead students into dangerous situations that they do not have the skills to handle.  Thirdly, the confidence that is required to be an effective veterinarian also lends itself to a somewhat grudging ego.  I've encountered many vets and vet students who get offended when a producer challenges their authority.  True, most producers don't have the medical knowledge we do, but most of them have been handling their livestock a lot longer than we have. 

I see our role as one of a teacher, medically, but often more as student, when it comes to handling.  Coming in with a chip on your shoulder because a rancher won't let you run his chute isn't going to make him more inclined to listen to your medical advice.  I've heard many of my female cohorts in large animal medicine complain that they aren't given the same respect that a male student would receive, and I'll grant, guys probably don't have to hear comments about how surprising it is to find a "pretty little girl" in the middle of a muddy working pen.  My question is, how is getting pissy going to make the situation better?  In my experience, if you suck it up, do your job, and display a basic level of competence, the respect will soon follow.  I love working cattle with grumpy old men, because they usually know a lot more about handling than I do, and I can learn something from watching.  Part of this is a culture difference.  I had the good fortune of growing up around a lot of grumpy old cattlemen, so I know the basics. (Don't stand in the gate like a bad dog, keep your mouth shut when the work is being done, don't chouse someone else's cattle any more than you need to to get the job done, and keep a cooler of cold beer in the truck.)  Keeping your mouth shut and your eyes and ears open is the first step to being treated like a hand.  Even if you think that asking non-stop questions will show that you are eager to learn, observation usually goes further with the ranch set.  Questions can come later, over the afore-mentioned cold beer, once the cattle are back out on grass.  If you can help, do, if you can't, stay the hell out of the way!

The final tool in the quest for livestock handling competence is being smart enough not to get killed, while being dumb enough to keep trying until you get the job done.  Working with large animals, or any animals, requires feel and timing.  You can study every word written on the topic, but until you get out into the working pens and move too quickly or in the wrong direction, you won't be able to get it right.  When I was a teenager, my first paying job was halter-breaking yearling colts for a neighbor.  I'd been around horses my whole life, but I learned a lot from being turned loose with a bunch of big ranch yearlings.  The boss and his sons fitted them with halters and long drag ropes, then they were all turned loose in a pipe trap and I was left to my own devices.  I learned patience, after losing yards of skin to rope burns, getting kicked, struck at, and drug around the pen.  I learned horse psychology, body language, and basic physics. 

A while back, a classmate and I headed into one of the school barns where two mares waited in stalls for us.  We had been told that one of them was prone to kicking.  As we walked in the door both mares lifted their heads and looked at us, I pointed to one stall and told my classmate, "That's the crazy one."  Granted, I had a 50:50 shot, but I turned out to be right.  The classmate, who had mostly small animal and exotic experience, asked me how I knew.  I'm afraid I did a poor job explaining, but I could tell from that first look which one was likely to be the kicker.  I tried to explain how her expression, the way she held her ears and the look in her eyes, suggested that she was defensive, even when we first walked in.  The other mare was just hoping for some feed.  Things like this are the things that can't be learned in the classroom.  I know there isn't time for it, but I wish there was a way for every aspiring large animal veterinarian to spend a few years working ranch horses and cattle.  Even if your practice is going to be more backyard pets, if you can get a Brahman range cow to cooperate, a pet Angus will be a cinch.  I think it would decrease the number of my classmates who will practice large or mixed animal medicine for a few years before getting injured or burned out and moving to small animal exclusive practice.

Sunday, August 26, 2012

Know When To Keep Your Mouth Shut


OK, I needed to write something irreverent to make up for all the deep thoughts I’ve been having lately.  This is a tale of the occupational hazards that accompany my profession…I have been limited as to how much information I can give when I’m at school because of client confidentiality issues.  Many of my patients have singular personalities and diseases, to where it would not be difficult for anyone loosely associated with the institution to pick out who I’m telling tales on, but this one is pretty generic, and names are withheld to protect the guilty. 

I was on necropsy duty recently. (For any na├»ve to the ways of veterinary medicine, this is like an autopsy for an animal.  We take apart the dead things and see what made them stop ticking.)  On the table was a horse that had colicked and died.  He hadn’t been dead long, but due to the nature of his illness he was bloated up like a giant, hairy balloon.  We wear a lot of gear on the necropsy floor; coveralls, rubber boots, long latex gloves, safety glasses, and thick cotton “cut” gloves to protect your non-knife-wielding hand is the minimum.  Things get more complicated when there is a potential zoonotic disease case, but colic is generally pretty safe for the bipeds in the room so we were in basic gear.  I made the first few cuts, then began the ticklish procedure of opening the abdomen.  Why is this the ticklish part, you ask?  Because when a horse is bloated, it is easier than ever to pierce a pressurized piece of gut, which results in rapid deflation accompanied by a projectile rush of fetid air, rank fluid, and partially fermented feed material.  I went at this horse like a bomb squad rookie, enduring mild ridicule from the duty clinician for taking so long to get the abdomen open.  I didn’t keep track of time, but I’d estimate I took around 20 minutes to carefully slice through the various abdominal muscle layers to reveal the shining, fragile peritoneal membrane.  Once there, I still had to make final landing, so I tried the old trick of “tenting” the peritoneum with a pair of forceps to lift it gently away from the pressurized intestines clamoring for exit just below the surface.  Tenting was a no go, the membrane was already stretched to the limit.  After making sure my safety glasses were in place and my mouth was closed, I tickled the peritoneum with my eight-inch necropsy blade as the rest of the crew stood at a safe distance, offering “encouragement.”  The membrane parted like an electronic gate and an unviolated loop of small intestine crowded out of the newly made opening.  Now, I could safety up and use the metal bar of my forceps as a stop as I finished removing the muscular wall.  Success!  I had opened the abdomen and I was not covered in intestinal schmoo! 

Once the abdomen has been laid open, the next step is to lift the back edge of the rib cage and stick a knife through the diaphragm, checking to make sure that the thoracic cavity was still at negative pressure and opening the way to come in with the long-handled rib crackers in order to remove the rib cage and allow full access to the lungs and heart.  The duty clinician stepped forward to make entry into the thoracic cavity as I stood nearby with the giant metal yard implement, ready to clip some ribs.  My mentor lifted the back of the rib cage and made a quick stab into the diaphragm.  Suddenly, I was hit with a rush of not-so-fresh air and a light baptism of green-flecked material.  The view from behind my safety glasses was…well, gritty.  Thankfully my mouth had been compulsively clamped shut as the knife made its arc.  The clinician looked at my shocked expression and said, “That was just the thoracic cavity.”  Ummm, well, ok.  I guess having green chunks in the thoracic cavity would help explain why this horse had died, but if the diaphragm had a hole in it, and the gut also had a hole allowing feed material to escape, wouldn’t that have released some of the pressure before we started opening cavities?  Upon closer inspection, we discovered a tiny, clean (read: made by a sharp blade and not by overwhelming pressure from inside) slit in a section of the large colon that was up by where the ribs connects to the spine, where it does not belong.  Welcome to veterinary medicine, where keeping your mouth shut is almost never a bad decision.

Wednesday, August 22, 2012

Sometimes, Death Pisses Me Off

I try to keep this blog on a positive note, even with the twisted nature of the profession I've chosen I can usually find at least some dark humor in things, but today has been a hard day.  We're coming up on exactly one year since Big Man died, we're at six months since losing my friend Brent to cancer, and working on the third month since another friend took his own life.  I've always had a temper, but I've been struggling with irrational rage over this suicide.  He and I had been friends since I was in high school.  He was actually my first boyfriend.  We only dated a few months, but we stayed in touch afterward, I was just young and didn't want to be tied to anyone.  I'm not the best about staying in touch, but we generally got together once or twice a year and talked on the phone once in a while in between, which is doing pretty good considering I've lived in a different time zone since I graduated from high school.  He was a hard-luck case, struggling through life, often due to poor choices and too much beer.  It could just as easily been me if I hadn't gotten a good college scholarship and had some other lucky breaks.  Rationally, I know that there isn't anything I could have done to save my friend...but the irrational part of my mind is unrelenting. 

One part of my mind is angry that I didn't stay in closer touch with him.  It had been nearly a year since we had talked.  Another friend actually talked to him the night of the suicide, though, and had no indication of what was coming.  I know that my opinion still held some sway on my friend, and if I had known the hell he must have been in, with alcohol and hopelessness, I could have pushed him on through the low parts.

Another part of my mind is absolutely furious with him for choosing this route.  I want to physically shake him and curse him for leaving us.  I want to tell him that he was acting like an emotional teenager.  I want to tell him to grow the hell up and be there for the people who need him in their lives.  Through the course of our friendship, we both did stupid things.  I thought he knew that I was always going to be a friend to him, whatever he had done or needed.  We lose enough good people too early due to accidents and illness, checking out the way he did was absolute bullshit.  I won't say there wasn't a time that I considered suicide, but my good friends got me to the other side and helped me see that I could survive anything if I just kept moving.

I guess if I were into pop psychology, I would say that I lack closure over my friend's death.  I received the news over the phone the morning after it happened and it was like a punch in the gut.  I never got a chance to say goodbye or tell him he was being stupid.  The other recent deaths I've dealt with aren't easy, but at least they both knew things were winding down.  They had done what they could to put it off, they were simply out of options.  Their family and friends were as prepared as you can ever be to have a piece of your life ripped out.  It's just the abject wastefulness of losing my friend to a self-inflicted gunshot that pisses me off. 

Tuesday, June 26, 2012

Extern-a-palooza 2012

Four more days until I get to shower in my own (well, my own rented) shower and sleep in my own (also rented) bed again.  I left home 3.5 weeks ago and have been on a wandering odyssey filled with horses, veterinarians, veterinary technicians, veterinary students, chiggers, baby racoons, a small hawk, a Mississippi Kite (the original Angry Bird), bucking horses (a different and vastly superior sort of equine), Mexican gangsters, clones, strippers, wanna-be bikers who think it's ok to hit on me, and assorted small mammals.  I have slept on eight different beds or bed-like surfaces during this time.  My truck is currently 500 miles overdue for an oil change and the state inspection expires in five days, though I believe there is technically an additional five day grace period after the actual expiration.  I am a nine-hour drive away from home and I will be making the return trip with 12 lbs of Miniature Australian Shepherd/hummingbird on crank mix dog.  I'm not sure anyone will survive, least of all, me.  Several articles of clothing have been lost to permanent green "recip mare on alfalfa diet" staining, and I am convinced that several gallons of panhandle dirt have worked their way deep into my pores and entered my bloodstream.  On the whole, it's been a fantastic road trip.

Saturday, May 5, 2012

The Final Finals, Part 2


Tuesday, D-Day #2, 0618—Have already been studying so long this morning I’m thinking it would be fun to theme a foal crop’s names based on random diseases…”Pelvic Pyelectasia” “Hydronephrosis” “Calcinosis Cutis” “Macrocantharynchus Hyarudinaceus” “Hydatid Cyst” “Lymphosarcoma” “Renal Adenocarcinoma”



0826—Just colored on my iPad screen with a Sharpie highlighter.  1 hour and 34 minutes until the ultimate radiology smackdown.  Fueled by a low carb Monster energy drink, smoked almonds, Skittles, and a cup of coffee.



1112—Find empty couch on 3rd floor of vet school and settle in to do reading/homework for my afternoon class. (“What?!” you ask, indignantly.  “Class AND homework DURING finals??”)  (“Yes,” I reply,  “because vet school blows.  And just when you think it can’t get any worse, it does.  That’s what vet school is.  Just one ‘Worst Day of Your Life’ after another.  For four years.  And then you owe the government a lot of money.”)  It wasn’t done earlier because it was sent to us yesterday, and I kinda had a few other things come up. 



1532—Came home, dispensed veterinary advice, cleaned the grey kitten’s eyes again, fed my horse, watched the kittens hiss and spit at the dog while he looked puzzled and wagged his tail, collapsed into bed.



1755—Microwave pizza and Golden Girls reruns.  Only one more final, and it is of the “take-home” variety.



2245—Stupid rebound insomnia.



Wednesday, 0832—Finals hang-over.  It’s like a drinking binge, without the good times.  Staying close to the couch and taking all the OTC cold medicine I have in the house.



1230—Feeling mildly improved, time to go to class.  Pick up last final exam, spend two hours talking about horse penises, and two hours talking about cattle who have eaten things they shouldn’t.  Highlight of the day is walking between classes, come upon a technician pushing a cart down the hallway with a bloody garbage bag on it.  After exchanging greetings, he quips “I’m the only school employee who actually gets a head.”  (Yep, read it again, you’ll get there…)  Ah, veterinary humor.



2129—Finally done with exams, just have to remember/manage to turn it in by 10 AM tomorrow.



Thursday, 0858—Turned in exam, turned in time sheet for work, back at home to play with kittens and get dressed up for make-believe time (aka, communication training).



1800—Made it through communication play-time, got a few hours at work, arrived at home feeling like I had been drug through a knothole backwards.  My throat is revolting, and the rest of my body is threatening to join the overthrow.  Begin self-induced Nyquil coma.


Saturday, 2146--Finally able to stand up without vertigo.  One more day before 4th year clinics start.  Have yet to start on the giant to-do list I had hoped to knock out, and have backed out of all plans for fun with friends.  Ugh.  "It will all be worth it someday," right?