Wednesday, January 25, 2012

Late Instruction

In usual vet school style, I had to attend "communications training" today.  This pattern of being put to the test, then receiving instruction has become the norm over the past few years.  Of course, the scenarios we went through today were different than most of what I have faced in real life.  The "clients" were actors, and the "patients" were stuffed dogs and cats.  Unless you've ever tried to interact with a live client and a stuffed patient, you don't realize how much we, as veterinarians, rely on the animal to connect to the person attached to it.  The first setup we worked on was with a client who had just obtained a new dog after the death of her father.  During our feedback session, one of the suggestions our instructor made was to ask about the father...his name, how he died, etc.  I know that this is just my personality talking, but I would have shut down anyone asking about Big Man that soon after he died.  Unless you knew him, you couldn't understand.  The only reason I told anyone at school what was going on was because I knew I was acting like a basket case and didn't want them to think I had gone around the bend for no reason.  I know different people react differently, and some people like to talk about their troubles, but I don't think I'll ever be the veterinarian who asks about your dead relatives unless I knew them too.

The day wasn't all annoyance, though.  Highlights included trying to keep a straight face while a teenaged actor played the role of an overweight client (with the help of a few extra stuffed animals under his jacket) with a heavy foreign accent, and hearing one of my classmates use the phrase, "Well we can try a behavior-modifying drug like Zantac..." when on the spot and trying to find the word "Xanax."  Yeah, vet student humor.  We find strange things hilarious.

Thursday, January 5, 2012

Client Communication...In the Trenches!

The past couple of weeks have been outstanding! I`ve been back at the equine clinic I worked for before I got into vet school doing my first "official" externship here. I know that I`m learning a lot in school, but I always feel like I absorb so much more from my mentors at the clinic. For one thing, it`s one-on-one (or sometimes three-on-one) interaction and I can`t hide behind somebody smart if I don`t know an answer. I`m expected to speak up and I`m mocked (somewhat gently) if I say something outlandish. After 10 minutes of intense grilling today...which included an "Explain your radiographic findings to this client and list the treatment options" with no notes to consult, a very vague history of the horse`s use and problems, a brief lameness exam in which I was jogging the horse so I could only estimate how he was moving by the sounds he made behind me, and an actual client that I had never spoken to sitting beside me looking at the radiographs...I have a better understanding of equine tarsal osteoarthritis than I did after months of classroom instruction and thousands of dollars in tuition money spent. I floundered for a while stammering through some doctor words that I`ve worked very hard to learn, only to be told "Now explain it in a way that he can understand exactly what is causing this horse to be sore and how we are going to fix it." I was stumped. I made some inadequate hand gestures, did some pointing at the x-rays, mumbled about joint spaces and bone spurs, and Dr. B finally took pity on the team roper client and summed things up with an analogy of twisting a stack of silver dollars. As long as the surface is smooth, they roll right over each other. If you whack the edge of one of them, creating a divot and a point, the point will grate on the dollar below it. Simple. Dr. B has been in equine practice since before I was born. He is a brilliant veterinarian and an excellent mentor, and most of his clients adore him. I`ve heard him explain things to clients before and have tried to learn from him, but I know that what I learned today will always stick with me. He is also a great teacher and lives to grill students. Even when I worked for him as a technician, he knew that I was working toward going to vet school and has done a lot to enhance my education. Now that I am a third-year, I am subject to full-force grilling and it is definitely effective! He is tough, and he will give me hell if I say something incorrect, but I know that he is doing it in hopes of making me a better, or at least adequate, veterinarian. I have somehow blindly managed to meet and work with some of the best equine veterinarians in the business. God`s hand has been guiding my career even when I am completely oblivious. I interviewed for a job with Dr. B when I barely knew what it took to become a veterinarian and was fortunate enough to make him believe that I could do it. Another tough client interaction scenario came up last week. I went out on an emergency farm call with one of the interns at the practice. The call was for a 2-year-old stallion that had fallen down in a pen and was unable to rise. When we got to the farm the horse had gotten up but one front leg hung useless. Further examination revealed all signs pointing to a fractured humerus, and likely a severed radial nerve. Fractured humeri are rare, especially for a young, healthy horse falling in a pen with relatively soft dirt, as this one had. The owners were distraught, but practical. We euthanized the horse. Our only other option would have been to try to stabilize the fracture, which was closed but already substantially displaced, and transport the horse to the clinic. The 45-minute trailer ride probably would have worsened the situation. Surgical fixation of the fracture would have been difficult, if not impossible, and recovery from anesthesia would have been dangerous. Even if surgery and recovery were successful, the road to healing would have been long and hard for this horse. I would never presume to judge someone`s decision in matters of euthanasia for their animals, but I definitely feel that these people made the right call in putting the horse down right away. A couple of days ago, I went with another veterinarian to where the owner works to do some routine health care of the horses he rides there. I found myself in a conversation with the owner about the horse we had put down. He wasn`t really questioning the decision, but he admitted that he was disheartened by the whole situation. I sympathized. Euthanasia is something I feel strongly about. I don`t think I would feel right doing it if it was something I took lightly. I believe in our role as caretakers for our animals we sometimes have to make the hard decision to end their suffering. I am proud that I can help to stop the pain, even if it is in essence admitting defeat. I don`t know if I was able to make this man feel any better about losing his horse, but I was able to honestly and wholeheartedly tell him that I agreed with his decision. I hope that meant something to him.