Class of 2015... How ya doing?

[Minnerbelle]

I've done 5 euthanasias in the past 24 hours.

Sucks...

I'm pretty sure that will be my Mon. The mon after a 3 day weekend is always a **** show.

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[LetItSnow]

Sucks...

I'm pretty sure that will be my Mon. The mon after a 3 day weekend is always a **** show.

Yeah. I'm day shift tomorrow. I'm pretty much dreading it.

 

[Gwenevre]

Legit question, is there a specific reason why the Monday after a 3 day weekend is so packed? Or why there's a lot of emergencies?

 

[LetItSnow]

Legit question, is there a specific reason why the Monday after a 3 day weekend is so packed? Or why there's a lot of emergencies?

Can't speak to the first, but as for the latter ... lotsa dogs outside getting whacked by cars and other dogs, lotsa fireworks-fearing dogs going through windows and screen doors and running out in front of cars, lotsa dietary indiscretion dogs, potential for heat stroke ... blah blah blah. Just kinda goes on and on. And then on top of it a lot of regular clinics were closed today so people who just have the normal day-to-day things that started Thursday night will get all jittery and decide they have to come see us instead of waiting until Monday to see their vet (which makes sense .... I'd much rather they come early than too late). So you take those factors and add in that summer Saturday days are usually super busy <anyway>, and it's just depressing.

I mean, we're overworked on a summer Saturday to begin with. So add in just a couple cases - say a bad HBC and a heatstroke and dog fight - and it pushes things over the edge into 6-hr wait times.

 

[dyachei]

Legit question, is there a specific reason why the Monday after a 3 day weekend is so packed? Or why there's a lot of emergencies?

well. usually people return to their routines. or they get home after vacation. A lot of clinics are closed so people tend to put things on hold

 

[Minnerbelle]

Yeah. I'm day shift tomorrow. I'm pretty much dreading it.

Yup, ER is slammed on the day of the holiday, GP is slammed somewhat the day before, and totally the next open day after.

July 4th last year, I was all alone by my lonesome self manning a busy ER having been working as a doctor for just a month. I'm pretty sure I legit have PTSD from that day. Something like 14 cases came in within the first 3 hours of my shift. Boss was like totally gone too.

I want to puke just thinking about it.

 

[LetItSnow]

Yup, ER is slammed on the day of the holiday, GP is slammed somewhat the day before, and totally the next open day after.

July 4th last year, I was all alone by my lonesome self manning a busy ER having been working as a doctor for just a month. I'm pretty sure I legit have PTSD from that day. Something like 14 cases came in within the first 3 hours of my shift. Boss was like totally gone too.

I want to puke just thinking about it.

Yup. That's my tomorrow. At least I have three good techs.

 

[SocialStigma]

Survived my first week as an intern on ER. TGIF!

 

[Minnerbelle]

Legit question, is there a specific reason why the Monday after a 3 day weekend is so packed? Or why there's a lot of emergencies?

So yeah pretty much what LIS said. On days people are home and not at work with their pets waiting peacefully at home, they tend to notice things about their pets that they normally wouldn't have and then randomly get paranoid about it (i just noticed that this one rib on my dog feels a little different from the others and I was reading online that it might be cancer!!!), or they do things with their pets that gets them in trouble. Add in the heat stress, the barbecues (cue FB ingestion, pancreatitis, gastroenteritis), the trauma (oops ran over the dog with an ATV), the hit by cars because the pets are outdoors and get loose, and the poor anxiety dogs that go bat**** crazy with fireworks and injure themselves or work themselves up into respiratory distress/hear stroke. Add to it the normal regular issues that need to be addressed same day, but regular clinics are closed.

Monday after a three day weekend is horrible for GPs because all the pets whose owners were too cheap/stupid to not take to the ER when truly indicated are half dead. There is also a buildup of all the Nonemergency/wellness/recheck things that you weren't open to see on Sat (when you're normally open) that are all built up by Mon. Mondays are usually the busiest day to begin with for this reason since we're closed Sundays... so having another extra day is awful. There is also a ton of "I know fluffy needed to be put to sleep but I wanted to wait until after the holiday when family members could come home and say goodbye." Last time I worked the day after a three day weekend we euthanized 6 pets!

 

[Minnerbelle]

Yup. That's my tomorrow. At least I have three good techs.

Ew good luck. I wouldn't wish it on my worst enemy.

When it was that busy and especially when I wasn't very efficient, the bottleneck was absolutely me myself and I. The techs were certainly occupied, but I was definitely the limiting factor

 

[LetItSnow]

Ew good luck. I wouldn't wish it on my worst enemy.

When it was that busy and especially when I wasn't very efficient, the bottleneck was absolutely me myself and I. The techs were certainly occupied, but I was definitely the limiting factor

Yup. That's me - the limiting factor. I pretty much just keep reminding myself that come 8pm I quit seeing new cases. I may still have 6 hours of procedures to do, but no new cases after 8pm. So no matter how far behind I get.... Clock resets (sorta) at 8pm. And I'm off Sunday because it's my transition week (to Mon-Tue-Wed).

 

[DVMDream]

It is really sad to take a look at a controlled drug log in a veterinary clinic around just about any holiday. Especially around Thanksgiving and Christmas, the amount of euthanasia solution logged is just sad.

 

[pooter]

I'm scared. Saw four ER cases today--all pretty simple, outpatient workups, but nothing feels simple when you're still getting used to being called by the D word. Would have been way worse if my senior hadn't been protecting me. I think she did about 5 euthanasias in a six hour period. Tomorrow will probably be worse, and I'm still kind of traumatized from the *last* July 4th. I'm so damn lucky to have my seniors. And my internmates, who are uniformly awesome. At least we'll all be overwhelmed together.

 

[scb44f]

VPB with crystalluria. Resident got a Bonanno catheter in at presentation. After many attempts to secure venous access, the clinician finally got an auricular IV catheter in. Pig becomes progressively more uncomfortable while owners are standing over him today. Finally get them to leave and are able to address his pain appropriately. He pulls out his catheter sometime this am (about 15 hours after getting it in). Meanwhile, I slept for 2 hours. Get called about the catheter. Realize the alarm I had "set" was no longer on my phone at all.

Meeting more of bf's family today. Wouldn't have woken up in time to make it at a decent hour. For once, I'm thankful my phone rang at 3:30 am.

 

[Minnerbelle]

VPB with crystalluria. Resident got a Bonanno catheter in at presentation. After many attempts to secure venous access, the clinician finally got an auricular IV catheter in. Pig becomes progressively more uncomfortable while owners are standing over him today. Finally get them to leave and are able to address his pain appropriately. He pulls out his catheter sometime this am (about 15 hours after getting it in). Meanwhile, I slept for 2 hours. Get called about the catheter. Realize the alarm I had "set" was no longer on my phone at all.

Meeting more of bf's family today. Wouldn't have woken up in time to make it at a decent hour. For once, I'm thankful my phone rang at 3:30 am.

Pigs are the worst patients.

 

[JaynaAli]

I finally got to leave yesterday's 1pm-midnight er shift this morning at 7:30am. Holy holiday er rush, you guys were right! I have less than six hours to grab a nap, eat, walk the dog, and be back.

I am awed by those of you that do this alone...thank goodness I have an er clinician with as many years of er experience than I have been alive and great techs to hold my hand most of the time.

 

[Coquette22]

VPB with crystalluria.

I wouldn't even know where to start.

 

[that redhead]

Monday is my first day as surgeon. I'm sure they'll be easing me in and I know there will be docs around, but I want my hand held, dammit. I don't want to be a big kid.

 

[cowgirla]

I wouldn't even know where to start.

Bacon.

 

[jmo1012]

Monday is my first day as surgeon. I'm sure they'll be easing me in and I know there will be docs around, but I want my hand held, dammit. I don't want to be a big kid.

i REALLY want my hand held! being on crazy busy ER with only 1 senior around for several interns scares the crap out of me! i want you to question my plan, read my discharges

 

[scb44f]

I wouldn't even know where to start.

They tend to get struvite crystals. The goal was to acidify urine (vit C is commonly used because they will eat the chewables) and give IVF. We are doing surgery this morning. I wasn't given much information beyond that. I think my boss wanted me to focus on meeting the bf's family. (She actually read my mind after I found out the pig was hospitalized and said, "You're still going. This pig isn't keeping you here on Saturday.")

On that note, meeting the family went overall well. Like I said, I got <2 hrs sleep on Fri. night. Visited them. Decided to stay and socialize with the siblings and their SOs because who knows the next time I will get that opportunity. Got another 2 hours of sleep last night and just pulled back into town not long ago. Time to go review this procedure.... YAY SURGERY!

ETA: bacon is also an acceptable answer, but maybe not with VPB...

 

[Coquette22]

Dear clients: Please stop calling the emergency line if you have zero intention of actually coming in. The emergency line is for emergencies. If your "emergency" can suddenly wait until Monday when I tell you about the emergency fee, it's clearly not an emergency.

 

[LetItSnow]

25 1/2 hours, one pericardial effusion, three surgical patients, and countless other patients later, my Fourth of July shift is over. Yeah!

 

[Coquette22]

And out of 9 calls, the only one that wanted to come in was the one who probably didn't need to. Whatevs. Can I be off call now?

 

[DVMDream]

And out of 9 calls, the only one that wanted to come in was the one who probably didn't need to. Whatevs. Can I be off call now?

Yes. You may be off call now.

 

[Coquette22]

Yes. You may be off call now.

Except I'm not. I'm on until 8AM tomorrow. But thanks!

 

[DVMDream]

Except I'm not. I'm on until 8AM tomorrow. But thanks!

Just tell them your random internet friend said you don't have to be on call anymore...

That should work, right?

 

[pooter]

**Wraps LIS in a snuggie and hands him coffee**

 

[nyanko]

July 4th last year, I was all alone by my lonesome self manning a busy ER having been working as a doctor for just a month. I'm pretty sure I legit have PTSD from that day. Something like 14 cases came in within the first 3 hours of my shift. Boss was like totally gone too.

I worked by myself on Easter. Me and 2 technicians. Similar results.

 

[that redhead]

Yesterday went as well as it possibly could have One particular doctor in the practice has been so awesome to me and she scrubbed in and helped move clamps around/made sure I wasn't doing anything stupid but let me do everything. Then I did my first extractions (well...gentle traction on two rotted ones, mild elevating/wiggling on the canine) on another cat. Feeling good

 

[LetItSnow]

Can't speak to the first, but as for the latter ... lotsa dogs outside getting whacked by cars and other dogs, lotsa fireworks-fearing dogs going through windows and screen doors and running out in front of cars, lotsa dietary indiscretion dogs, potential for heat stroke ... blah blah blah. Just kinda goes on and on. And then on top of it a lot of regular clinics were closed today so people who just have the normal day-to-day things that started Thursday night will get all jittery and decide they have to come see us instead of waiting until Monday to see their vet (which makes sense .... I'd much rather they come early than too late). So you take those factors and add in that summer Saturday days are usually super busy <anyway>, and it's just depressing.

I mean, we're overworked on a summer Saturday to begin with. So add in just a couple cases - say a bad HBC and a heatstroke and dog fight - and it pushes things over the edge into 6-hr wait times.

Interestingly enough ... I saw not a single HBC (the only broken bones I saw were a dog that got caught in something while running and snapped a radius/ulna), not a single heatstroke, not a single dogfight, and not a single fireworks-related (i.e. goes through a window and lacerates) case in the entire 25 hours I was on (8am 7/4 to 9am 7/5). Nevertheless it was stupidly busy (people literally sitting on the floor in the waiting area) and we did a few FB surgeries overnight once things quieted down enough that I could get into surgery.

Sigh. I don't get it. Three day weekends are just anathema.

 

[pooter]

Sigh. I don't get it. Three day weekends are just anathema.

We had lots of non-emergent emergencies. My "favorite" was the dog who had vomited twice in a ten day period who showed up with the 3 PM rush on the Fourth. With no money for diagnostics of any kind because, of course.

 

[jmo1012]

We had lots of non-emergent emergencies. My "favorite" was the dog who had vomited twice in a ten day period who showed up with the 3 PM rush on the Fourth. With no money for diagnostics of any kind because, of course.

i had a represent on the 4th who had declined everything the night before for vague symptoms and then claimed more vague symptoms the next day and the 1st thing out of their mouths was that they werent interested in diagnostics...some persuasion and we did some bloodwork thankfully, but sheesh.

i am le tired. so very glad tomorrow is my day off after a very long 6 days with very little sleep. of course we still have rounds at 8 and i'm on call every night this week, but there will be some serious sleeping tomorrow!

 

[Minnerbelle]

i had a represent on the 4th who had declined everything the night before for vague symptoms and then claimed more vague symptoms the next day and the 1st thing out of their mouths was that they werent interested in diagnostics...some persuasion and we did some bloodwork thankfully, but sheesh.

i am le tired. so very glad tomorrow is my day off after a very long 6 days with very little sleep. of course we still have rounds at 8 and i'm on call every night this week, but there will be some serious sleeping tomorrow!

I love it when I see on the schedule some serious sounding presenting complain with a note that "O wants exam only. Not interested in any diagnostics. Does not want dr to talk about diagnostics." It makes me want to punch the receptionist who put that in, because it makes it seem like the doctors should be sensitive to such ludicrous requests. No, "ok, I'll let the doctor know" is not an acceptable response to such statements.

I also hate it when people come in for "dental emergency" when I have very recent exams and notes with strong recommendations for dentals that the owner declines. Then they come in as an emergency because the bad breath is just all of the sudden unbearable. And then you just go in and look at the same old rotting painful mouth and shrug and go, so would you like that dental? And the answer is no. And then when you blankly stare at them and explain again that without removing source of infection/inflammation/pain/rot/pus/debris, the problem won't go away and putting the pet on abx for life isn't an option. The answer is still no. And then you offer pain meds, and of course it's declined because all the owner cares about is the bad breath. And then you state at them some more, and they go "so that's it? You aren't going to do anything? So you don't care?" Then you just scowl and say, well we can do something, your dog needs a dental. And then they get pissed and leave. Seriously happens all the freaking time.

Argh... Just like a blocked cat needs to be unblocked, a FB needs to be cut, and a closes pyo needs a freaking spay... Rotting teeth have to come out! Why is that so hard to understand?????

What is equally as annoying is when they actually then decide they want a dental. But then now it's an emergency and they want it done tomorrow... Even though your surgery schedule is full for at least a month.

 

[LetItSnow]

Argh... Just like a blocked cat needs to be unblocked, a FB needs to be cut, and a closes pyo needs a freaking spay... Rotting teeth have to come out! Why is that so hard to understand?????

Apparently it's difficult even for some of us. I just had a GDV show up last week with RDVM rads, correctly diagnosed as a GDV, and the RDVM warned the owners that I would "probably recommend surgery, but that medical management is an option."

What can you do. Shrug and move on.

 

[Minnerbelle]

Apparently it's difficult even for some of us. I just had a GDV show up last week with RDVM rads, correctly diagnosed as a GDV, and the RDVM warned the owners that I would "probably recommend surgery, but that medical management is an option."

What can you do. Shrug and move on.

Wow... How many GDVs has that rDVM cured with medical management? Though I did have a (bad) professor once suggest that we should trocharize then hold the dog upright and vigorously swirl the dog in the opposite direction of the volvulus... Huh maybe he moved up to MN.

Is that what the rDVM actually said? Or is that what the client decided what they wanted to hear though..? My rule in ER is almost never trust what the clients tell me because they lie about just about everything.

 

[LetItSnow]

Wow... How many GDVs has that rDVM cured with medical management? Though I did have a (bad) professor once suggest that we should trocharize then hold the dog upright and vigorously swirl the dog in the opposite direction of the volvulus... Huh maybe he moved up to MN.

Is that what the rDVM actually said? Or is that what the client decided what they wanted to hear though..? My rule in ER is almost never trust what the clients tell me because they lie about just about everything.

In this particular case it was in the transfer notes, so no, I don't think the client was making it up. I'd like to give the RDVM the benefit of the doubt and assume that when she wrote the medical management part she wasn't (at that point) certain if it was rotated or just bloated. But ... who knows. Her rads certainly were clear enough for a dx.

 

[scb44f]

Urogenital trauma during calving --> can't pee, and cow doesn't want to stand because she is painful so she lays there and looks like death until you cath her or get her up and she urinates --> called every night for her

Uroliths in pig --> place percutaneous Foley --> pig pulls it out --> he is happier and urine is still coming out the hole --> ooookay

Uroliths in whether --> urethral process amp not sufficient so Bonanno --> UA next day --> no crystals or bacteria --> wants to die --> reeval penis --> not encouraged by what we see --> banging head against the wall

I love uro patients, but srsly, 3 at once is more than enough.

 

[pooter]

Y'know that awkward moment when you glance at your schedule and realize you went to work on your day off and stayed home on what you *thought* was your day off . . . and no one said anything?
. . .
No?
. . .
Just me, then?

 

[that redhead]

Starting to run into the "She's sick/hurt/whatever but no, I don't want to do rads/surgery/whatever but I'm still really worried" people/animals. Ugh.

 

[LetItSnow]

Starting to run into the "She's sick/hurt/whatever but no, I don't want to do rads/surgery/whatever but I'm still really worried" people/animals. Ugh.

Yup it's life. I just try not to think about them once they're out the door. I euth'd a gorgeous super friendly cat last night because he reblocked and owners didn't want to give him another chance .... Then sent home a patient who had had 10 seizures in the last 6 hours with nothing more than an extra boost of pheno and two doses of rectal diazepam because that's all they'd do.... And then .... Etc.

Some people will take care of their pet and some won't. You can't let it eat you up whether their reason is good or lame.

 

[that redhead]

Yup it's life. I just try not to think about them once they're out the door. I euth'd a gorgeous super friendly cat last night because he reblocked and owners didn't want to give him another chance .... Then sent home a patient who had had 10 seizures in the last 6 hours with nothing more than an extra boost of pheno and two doses of rectal diazepam because that's all they'd do.... And then .... Etc.

Some people will take care of their pet and some won't. You can't let it eat you up whether their reason is good or lame.

I just can't help feeling like I should have done more/communicated better how important/helpful it is to do [whatever thing] :\ Objectively I know I did what I could and it's on the owner but ugh. Just ugh.

 

[scb44f]

****ty 90+ hour work week. That is all.

 

[JaynaAli]

Had a client tell my receptionist that she (the client) knew 'as much as the vet' (meaning me) because she 'worked in a vet clinic several years ago'. Oh lady, those are some of the few words that will instantly put you on my **** list. She also told the receptionist at one point that she 'knew how long stitches take and he should be finished already.' Shortly after, I sent a tech to update them that I was indeed just finishing and he was lying on the table waking up from sedation and we were then criticized for repairing the laceration with the dog on a table. Umm okay, the floor is a less than clean environment this far into a weekend evening ER shift especially since it has the dog's blood all over it, so idk what you expected lady. Just because he weighs 132 lbs doesn't mean we can't lift him.

I've never been so happy to send clients home so far, which was too bad because the dog was a really sweet Newfoundland.

 

[LetItSnow]

Had a client tell my receptionist that she (the client) knew 'as much as the vet' (meaning me) because she 'worked in a vet clinic several years ago'. Oh lady, those are some of the few words that will instantly put you on my **** list. She also told the receptionist at one point that she 'knew how long stitches take and he should be finished already.' Shortly after, I sent a tech to update them that I was indeed just finishing and he was lying on the table waking up from sedation and we were then criticized for repairing the laceration with the dog on a table. Umm okay, the floor is a less than clean environment this far into a weekend evening ER shift especially since it has the dog's blood all over it, so idk what you expected lady. Just because he weighs 132 lbs doesn't mean we can't lift him.

I've never been so happy to send clients home so far, which was too bad because the dog was a really sweet Newfoundland.

Isn't it grand? I saw a BDLD a few nights ago that resulted in a nearly circumferential neck laceration (it was actually pretty cool). When I told them it would take an hour and a half or so (I had other patients to see .... plus getting him sedated ... plus having my techs clip and flush the wound... plus sewing him up ... plus waiting to make sure he recovers from sedation ok ... plus writing the discharge ... plus getting the meds ready .... it's easily a 1.5 hr process), they just couldn't wrap their head around why it could possibly take so long. To their credit, they were very polite about it, but it was clear they were thinking "wtf? why does it take so long?"

I think that owners think we just take the dogs into the back and ask them to hold still while we sew it up quick. I mean, I talk through the whole process so they know what we're doing, but .... sometimes the knowledge just doesn't take hold.

If I had to pick one category of people who seem to consistently think they know better how to treat their animal, it's RNs. They pretty frequently overvalue their medical expertise when it comes to evaluating their animal.

 

[JaynaAli]

If I had to pick one category of people who seem to consistently think they know better how to treat their animal, it's RNs. They pretty frequently overvalue their medical expertise when it comes to evaluating their animal.

The tech monitoring sedation on the dog and I had this same discussion last night, and I said the same thing. Some are great clients but I've noticed that trend too.

 

[that redhead]

If I had to pick one category of people who seem to consistently think they know better how to treat their animal, it's RNs. They pretty frequently overvalue their medical expertise when it comes to evaluating their animal.

In fourth year, someone told us that an RN brought her essentially-dead dog to ER...it had eaten rat poison and she home treated it with broccoli because it has Vitamin K! ...

 

[heylodeb]

If I had to pick one category of people who seem to consistently think they know better how to treat their animal, it's RNs. They pretty frequently overvalue their medical expertise when it comes to evaluating their animal.

Without a doubt. No question.

 

[scb44f]

Today, I...

1) presented a case at pathology/food animal rounds
2) treated a cria with diarrhea
3) sedated a pig and acidified his urine
4) discharged my first of 3 blocked animals (still working on one, euth'd the other)
5) ate lunch before 8 pm for the first time in a week
6) received an after-hours call about a chicken (thankfully, it turned out to be about maggots, and the woman thought I was so helpful that she called back for more advice lol)
7) received an after-hours "I want to chat about my neurologic/dead calves, dead alpaca, and coughing calves, in that order" call

What a day.

Edit: add in there 8) taught students about the beauty of cut-downs over IV catheters in food animals and 9) put out many many "fires" started by the students, so to speak. This group has been...challenging...

 

[that redhead]

Today, I...

1) presented a case at pathology/food animal rounds
2) treated a cria with diarrhea
3) sedated a pig and acidified his urine
4) discharged my first of 3 blocked animals (still working on one, euth'd the other)
5) ate lunch before 8 pm for the first time in a week
6) received an after-hours call about a chicken (thankfully, it turned out to be about maggots, and the woman thought I was so helpful that she called back for more advice lol)
7) received an after-hours "I want to chat about my neurologic/dead calves, dead alpaca, and coughing calves, in that order" call

What a day.

Edit: add in there 8) taught students about the beauty of cut-downs over IV catheters in food animals and 9) put out many many "fires" started by the students, so to speak. This group has been...challenging...

I...gave a few rabies vaccines?