Friday, September 23, 2011

A day in the life, (a bad day)

This is supposed to be about my real-life. But sometimes my real-life gets so out of control crazy busy that there is nothing else in my life. It is part of the reason I love what I do. But it is also part of the reason that I have no children, few hobbies, and a diet no one should be proud of.
So I thought I would describe what my day yesterday looked like.  Yesterday was Monday. Mondays are notoriously bad. They are insane busy from the moment the doors open. I opened the clinic for appointments on Sundays just to try to reduce the volume of bad cases that we see on Mondays. It has helped marginally.
I don’t know if people are too busy to notice that their cat hasn’t peed since Thursday night. Or that their dog that was having trouble with stairs and walking is now paralyzed and unable to control their bowels.  Or that the cat that has been crying since Wednesday and now won’t let you touch him, and has blood erupting out of a wound on its back needs to be” dropped off right now because you have to go to work.”(And, oh yeah, you can’t go near him even on his “good” days). Or the morbidly obese Shih Tzu that just walked in with his whole family because they think that the dog is having trouble breathing and they “think it’s time.” Those were some of yesterday’s cases. This is my real-life. And this is a bad day.
About a month ago I tried to cut back my work schedule so that my routine crazy insanely busy days might be more bearable. I have been scheduling my Mondays and Wednesdays for surgeries for the last couple of years. I was waking up on Mondays like the rest of the world and dreading the drive in to work. Mondays were becoming too busy to get my scheduled surgeries done, and everyone was suffering for it. So I decided that I wouldn’t schedule anything on Mondays with the hope of being less stressed and better able to provide the time and care the patients needed. I am not really sure how I can still not schedule anything, show up to work and still be here for 13 hours but it happened yesterday, and it still happens most all of my Mondays.
I woke up early like I always do, called into the clinic to see what was already on the books from the overflow of the last week and was told that I only had three cat neuters scheduled for today. I thought “Great! 3 cat neuters takes about 30 minutes, I will have no problem getting them done! I don’t need to rush into work.” Then I asked how the other Vets on the exam schedule looked and Lindsay, the receptionist, told me that they were full. That means I needed to get to work ASAP to help cover any walk-ins/disasters so the Vets on the exam schedule don’t get behind. As I was getting out of the shower Grace from Animal Rescue called. She had three small dogs that were trying to rip each other apart and all needed emergency neuters. She also had three other dogs that needed to be either spayed or neutered. I told her I would fit the emergency neuters in but the other guys would probably have to wait. She said she would meet me at the clinic in 45 minutes. I started to apply make-up faster and ditched the idea of blowing my hair dry. Another day with wet hair drying in a ponytail it was. The phone rang again. Could I come in earlier and help with the emergencies that were already calling? “Yes, I will be there soon.” Throw bag of belongings into large book bag, throw three dogs into car, remember to give Midnight her thyroid medicine, put little baby Wren in his carrier, grab coffee, and  go.  Get to the clinic unload the garbage, three dogs, one small sickly kitten (Wren) pick up my bag and trudge into building. Deep breath, good thoughts, and jump in. Open staff entrance door, survey scene. First face I see is my very well trained, lots of experience, long time Licensed Veterinary Technician. She looks up from the rubble, and the first thing out of her mouth is “why are there 3 more dogs to neuter?” I think to myself, “oh my god, I just got here, the anxiety level can’t be at a 10 already? We just got here.”  She came back at me before I could reply, “ I still have all of the treatments to do, and we don’t have enough people for all of these surgeries.” It’s hard to walk into a hard day with complaints at the onset. I put my stuff down, reminded her that they were the rescue’s dogs and we didn’t have to do them first thing, and that we would be ok and get through this. It is a hard stressful incredibly busy job and my poor techs bear the brunt of it.
I only thought I had three little quick cat neuters to do. I was sooo wrong it was soo beyond an easy day. That busy crazy Mondays cases started with Daymin. I had Daymin to look at all day. Sitting in up in his cage panting , trying to get up but unable to. Trying to get up because his brain told him that this place, this hospital, is not a safe place, so his front feet try to dig into the un-grippable stainless steel cage, and his unresponsive back end just lays there like dead weight. He cries when you try to move him and he involuntarily urinates and defecates. It is the bodies response to pain, flight or flight, and the mixed up incorrect nerve responses that happens when your spinal cord is damaged. Because he was so miserable we gave him morphine to try to ease his pain and provide some sedation. This caused him to vomit a huge amount of…stuff… I think it was eggs and chocolate? Didn’t his owners realize that his back problems were in part caused by his obesity? He was covered in poop and urine and we couldn’t clean him up without causing him more pain and thus producing more poop and urine. While we spent the day trying to convince Daymins owners that he had slid steeply downhill and needed emergency neurologic intervention we kept Daymin sedated, listened to him moan in his dysphoric morphine slumber and waited. At 6 pm I told his owner that I could no longer watch or partake in his cruel care. I told his owner that the only options left for Daymin were to refer him for the spinal surgery he desperately needed or to end his suffering with euthanasia. Daymins owners consented to letting him go and for the first time in over 3 days he wasn’t in pain.Concurrently I was trying to help Simba. A sweet purring machine of a long haired domestic tabby and white cat who had not been able to pee for days. His bladder was hard and it was painful when you touched it. He needed to pee and he needed it bad. I have seen more than one cat die in the process of trying to unblock their bladder. I went through all of the steps in my head. Remove some of the urine via cystocentesis (poke bladder with needle and pull off as much urine as possible) gosh you feel soo much better after that. Retain urine sample, (in his case very very bloody), to submit to lab, pull blood to submit to lab, place i.v. catheter to start fluids and correct electrolyte imbalance,then place under general anesthesia because its bad enough to be blocked butrtheres npo way any animal will lay still as you try to skewer their penis. (Although I have had more than a few blocked cats be soo bad off that the anesthesia wasn’t needed, and would have probably been the last nail in their own coffin). Then start the arduous process of trying to thread a small piece of plastic into a very small, and plugged up, little hole. God I can’t even explain to you how many sweaty brow hours I have spent trying to thread that hole. I have figuresd out a lot of tips. Here are some of them for you newbies; try a catheter (22 gauge minus stylet), try lidocaine in your catheter, try the ultrasonic scaler. Its like a rota-rooter on your sensitive delicate urethral lumen but it busts that cement plug up like TNT. And god bless the tomcat catheters that everyone says not to use, but damned if I can ever get one of those red rubbers in. glue tomcat in with tape and Chinese finger trap. Tape and sew collection bag to the tail and don’t forget the e-collar, or you get to do the whole process over again tomorrow.  I also think that an important tip to remember is to give the cat some SQ fluids before leaving at night and then disconnecting their i.v. fluids. I have come in the next morning to find a big birds nest of i.v. line because the cat spun around all night and twisted the lines to the point that either the i.v. or urinary catheter gets pulled out. Luckily Simba did great. And luckily for me it only took an hour to unblock him.
Then there was Mac. Mac is a big outdoor cat who hates anything that isn’t done exactly on his terms. He was brought in this morning. His owner literally passed the carrier (with him in it) over to the technician and said “he has been gone for a few days and now is bleeding on his back”. “Ok”, my technician said, “let’s take him out and take a look.” “No!,” the owner blurted, “I don’t want to see him, and he’s not a nice cat.” “Can’t I just leave him here for today?” “You can’t touch him, even on a good day.”  And for some reason he was left for me too look at when his mood changed. I called the owner and got permission to sedate him before I lost a hand or needed plastic surgery. After ten minutes with some hard core drugs surging through his veins he was placid and cooperative. I liked Mac like this. We started shaving off of the furr covered in pus and blood. The more we touched the wound the more puss erupted. And when I say FOUL smelling, I want you to think dead fish rotting in the sun. bad doesn’t make you think you are going to throw up. does it? I wanted to. But I had three other cases waiting for me, he was already under anesthesia, so you just swallow, and keep plugging along. One hour later he had a 6 inch long drain running the length of his back. I called his mom to explain what we had done, and she of course asked me “ what o you think did that?” I told her that “ I couldn’t be sure but in most cases it is another male cat trying to get him to move to another block.” He was a mean mean pistol when he was awake. We let him wake up in his carrier. He spent the rest of his day hissing and spitting and swearing at anyone and everyone who dared to come close to his cage. His mom picked him up at the end of the day still afraid to look into his carrier and see what his wound looked like. she swears he is angel at home. I hope so, he is the devil outside his house. Bon voyage and good luck Simba!
Lastly I got called out of the back surgery area to look at a walk-in client with an older Shih Tzu who they think “is having trouble breathing, and it might be his time.” Lovely. I escorted mom, dad, daughter, and obviously obese older Shih Tzu into an exam room. Turns out their dog is morbidly obese, was groomed a few days ago, and now is soo painful he won’t eat or move. To think that these owners were contemplating euthanasia due to sore back is scarey. The appointment didn’t take long and I was happy to have this bullet dodged.
I left 13 hours after I walked into the building. I watched two shifts change. And I was exhausted. Little did I know that today, Tuesday would be worse.

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