abigail414's diaryland diary
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A Day in the Life
Last Thursday, I kept my schedule and notes from work. The previous post from my 'day off' was after this. If you're curious about what a vet 'really' does in a day, here you are:
8 am - Lonnie, an ancient Bichon dog who has walked drunk since puppyhood, developed seizures at about age 2, and has been on phenobarbitol and thyroid meds for the past 12 years is here for an exam. The owners are responding to a call I made regarding their drug refills, and came in for bloodwork to determine current medication levels - but they did not give meds this morning so blood can�t be taken and will come back another day. While we're there, Lonnie's eyes look bad so he gets a couple tests, a physical exam, and some new eye drops. (I'm now 15 minutes late, thanks to the eye tests).
8:30 am - Follow-up appointment for KitKat, a 15 year old spayed female calico cat with a butt mass. She was seen by another doctor here a week ago and prescribed antibiotics, which didn't help so we're going to biopsy it (with needle) of the mass and send it to a pathologist. The owner has no money, is mentally challenged, and needs to apply for 'Care Credit' (a loan company) to cover the procedure. So, I move on to my 9 am appointment while that process is being handled by others.
9:00 am - Jon, an old toy poodle, returns from yesterday. His owner is both mentally and emotionally challenged (bizarre to have two at once). He spent much of our time together yesterday looking at me with watery eyes and repeatedly saying 'I didn�t know dogs could be diabetic' - or just staring silently amd not responding at all. Jon is very ill � with advanced diabetes as well as pancreatitis (inflammation of the pancreas which can result in it digesting itself). Jon has a poor prognosis even with intensive care, but the owner wants to talk about how to make him better at home. I draw him a diagram � 1) Take Jon home, he will die a painful death (pancretitis hurts and diabetic ketoacidosis is no picnic). 2) Hospitalize with intensive care ($$$), he may live, or at least not be in pain. 3) Put him to sleep, he will not be in pain. Even after this diagram, he said "I don�t know what to do, I don�t know what to do� - so I asked if there was someone he could call (a lifeline?). I was hoping for a caretaker, but the closest thihng is a brother in a nearby town in Arizona. He leaves (like yesterday).
KitKat�s mom has been approved for $1,500, the procedure will only be about $200, so KitKat is taken to the back and put in a hospital cage pending sedation. I hope to get to her before lunch - I hate sedating cats, they can be unpredictable.
9:30 am - Mabel comes in, a very sweet old Doberman I have been working with who has advanced liver disease. We've kept her going with various medications and herbs, but she is now getting worse, and the owner opts for blood tests and another ultrasound to assess her prognosis. The owner really likes working with me, but I won�t be here for the ultrasound because I do get a day off once in awhile.
10:00 am - Joe the trauma cat�s owners are here to take him home. He came in flat out two days ago with subcutaneous emphysema, which is air in the tissues under the skin that feels like bubble wrap. It was most likely due to some trauma which we couldn�t see on x-rays or physical exam. He�s eating and responding and walking around, but stills feels crinkly to the touch. I take another quick x-ray before sending him home to be sure he is better and all lungs are inflated. Odd thing is, I called the owner in the morning to ask when they were coming to get him and a person answered who sounded like him but claimed another name and that he didn�t have a cat. Well, that�s one way to get out of an $800 bill - luckily, I was wrong and he did come in.
Also at 10:00 am, an elderly couple with Chelsea, a newly-diagnosed diabetic Schnauzer, have arrived for a repeat blood glucose reading, which is off the chart so we check her in to provide multiple monitored insulin injections and fluids. This was a dog I saw for hindlimb lameness a few weeks ago, they didn�t want diagnostics, so I sent them home with doggy Advil, and told them something else was really wrong with her that we would need to eventually figure out. They came back a couple days ago with her much sicker and agreed to a complete workup at a discounted rate for older dogs.
Btw, 10:00 am was my emergency slot to catch up on phone calls and paperwork, which didn�t happen.
10:30 am - Baker, a 14 year old golden retriever is here and having a hard time breathing � as if something is caught in his throat. He is very anxious in the clinic, which makes not only his breathing worse but his owner edgy. I feel around his neck and find hard masses - either lymph nodes or some kind of growth - and give him an estimate for sedating, aspirating, taking blood, doing some x-rays. By now the owner is really really anxious and just wants to get it done no sedation or x-rays, which does tie my hands but OK. So, I go poking at the firm lumps and get mostly blood, but send it off to a pathologist anyway. And I quickly draw blood for tests while the dog is in the room and send it on its way with sedatives (wishing I could do the same for the owner).
11:15 am - Maisey, a wiggly Boston Terrier pup comes in late, and has dandruff. Yay. Something simple, and I was running late anyway. Yes, she swims in the saltwater pool. Oh, and she�s due for a rabies vaccine. Her skin looks fine so I check with our groomer for her favorite dandruff shampoo, send her home with a conditioning spray and fish oil supplements, and tell the owner to hose her down after swimming.
11:45 am - I examine KitKat with the butt mass, ascertain it is actually on her vulva and is non-painful, so have an assistant restrain her and I take multiple needle samples with no sedation. I discharge my regular assistant on time for lunch, which is very important to the head technician.
12:15 pm - I make sure someone takes Chelsea the diabetic out to pee (diabetics pee a LOT), and wash her off because she came in covered in dried urine. I make a couple quick phone calls to move some charts off my desk, and zoom home to let my dogs in. They stay in a shady courtyard if it is cool enough in the morning. I zoom back to work to start addressing the piles of files and messages on my desk before my afternoon appointments arrive.
2:00 pm - A sweet Chihuahua/lab mix named Lucy has a lump on her abdomen. I poke it with a needle and it looks like fat. I do a quick physical exam and check the shot status and send the owner on his way, hoping to get ahead of the impending clusterfuck this afternoon.
Over lunch I approved a visit in my 5 pm emergency slot for a cat that is straining and had a urinary tract infection 2 weeks ago. I told the owner he may have to wait, but we�ll take x-rays (it has had a history of bladder stones) and check urine. Plus, I know that Chelsea�s owners are coming in to pick her up at that time, as well as another dog for blood pressure tests before being prescribed thyroid. And, my 3 pm emergency catchup slot has been filled with a recheck of an eye from 2 days ago.
2:30 pm - No show. Thank god! Jon has returned. His owner spoke with his brother who assured him that sometimes dogs need hospitalization and intensive care. I prepare a fairly large estimate and tell him he may spend the same amount at the emergency clinic for evening care (we are not open 24 hrs). I am hoping he opts for euthanasia because the prognosis is poor and I can see him becoming very confused if the dog dies in spite of our best efforts. Nope, he�s going to hospitalize, puts down some money, and we whisk Jon off to get on IV fluids, pain medication, anti-nausea drugs, and antibiotics. He will come back at 6 pm to take the dog to the emergency clinic.
Plus KitKat�s owners are here to pick her up � how can I again have two mentally slow clients here twice at the same time on the same day? What is the universe trying to tell me - get a tin foil hat? KitKat's owner wants to know if the tumor is because her husband stepped on the cat. I assure her that a mass on the vulva would require he put his boot in KitKat's vagina. She doesn't understand, and I need to explain what a vulva is. Oh my.
3:00 pm - Recheck appointment with Suzy the Shih Tzu because of an eye that had a small ulcer (abrasion) two days ago. After looking at the eye with a dye, the ulcer appears to have worsened in spite of eye antibiotics. Damn. I take Suzy into the back, numb the eye, and roll a sterile cotton swab on the cornea to get the dead tissue off and stimulate new growth � called debridement - and about half the surface sloughs off! I�ve done this before, but not made it look so very bad. I ask another vet to check it out, and he assures me that this is normal and to continue getting the surplus tissue off. When I'm done, I put an antibiotic-soaked contact lens on the eye to help protect it while healing and Suzy promptly gets it out so have to do it again. She goes home with a plastic cone on her head and instructions to come back within 4 days.
3:30 pm - Shirley the Chow comes in for swollen lumps under her jaw and excessive urination. The lumps are lymph nodes, and the rest of them (6 more you can feel) are all enlarged, which is not good. The owner approves bloodwork, urinalysis, and tapping the lymph nodes. I know this is probably cancer and the main question is how malignant is it. I send the urine out with the blood because I have no time to personally look at it today, and tell the owner I�ll call in the morning.
Yes, I�ll come in tomorrow on my day off and call on all the bloodwork and samples I�ve taken today. Human doctors can wait days and days, but people will call in if they don't hear about their pet w/in 24 hrs.
One of the other assistants gives my 4 pm vaccination appointment to another vet since I am 15 minutes behind, and she is a friend wanting to do me a favor. I regret not seeing a puppy, but it is fine because I need to make some more decisions about Jon's treatment and check in on Chelsea.
4:30 pm - Sandy and Bettina, a dalmation and an english pointer mix come in for annual exams and vaccines. They had been allotted an hour, but I took half of it away because I needed the 5 pm slot for other clients and thought one of the dogs was only coming in for a toenail trim. Nope, they both need the whole deal - so, I just take a breath and methodically go one at a time with history, physical exam, vaccines, then send to the back for toenail trims and dental hand cleaning. The owner opts to not test or prevent for heartworm for some obscure reason that I have no time to debate. I'm running late again.
5:00 pm - Melissa, the cranky urinary straining cat has arrived and the owner knows he will have to wait, but is grateful to be seen at late notice. I tell one of the treatment technicians we need an x-ray and urine from the cat so that I can figure out the next step. (And, magically, this happens).
5:00 pm - Sweetie, an overweight, thin-coated dog comes in for a blood pressure check before starting thyroid medicine. She is borderline hypothyroid, but has symptoms and I know how lousy low-normal thyroid can feel. Since her BP is normal, I send her home with a low dose of thyroid supplement.
5:30 pm - Chelsea the diabetic Schnauzer's owners are here to pick her up. I give a demonstration of how to do insulin injections, sending them home with supplies to start at 8 pm but am not optimistic that this will be easily controlled or simple.
5:45 pm - Jon's owner has arrived to take his dog to the emergency clinic after getting started on treatment here. He has a zillion questions and wants to take him home and I again bring out the diagram ��he will die a painful death� if taken home. I have typed out a brief history for the emergency clinic and fax it to them along with test results. I also brief another doctor here on the case so continued care can be provided tomorrow in my absence.
6:00 pm. I am finally looking at Melissa, the cat with urinary problems. X-rays confirm that she has bladder stones, but they haven't changed much since a month ago when she responded to antibiotics. Since bladder surgery is more difficult with inflamed and infected tissue, I give her a steroid injection(cats love steroids, btw), and antibiotics, schedule her for surgery in the morning if she is still straining.
6:50 pm. Everyone is checked out and my assistant leaves 20 minutes late, which will cause grumbling by the head technician. I have about 10 files left on my desk of people who need to be called, and some more prescriptions to approve. Luckily I have tomorrow off to make the non-emergency calls, so go home at about 8:00 pm.
Another 12 hour day in the trenches. I hope I made the right decisions to help those in my brief care, and as usual worry that I missed something. And, I hope that someday this will have more of a flow and not feel like fighting one fire after another - or I won't hold up. Time to get some rest to start over again tomorrow
9:00 pm. - 2006-08-23
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