I heart science. It’s a huge part of why I’m in this field. I like that there are causes and effects and rules and explanations. I’m a total fangirl when it comes to evidence-based medicine and I geek out over a good math equation. I have also developed a passion for emergency medicine and triage. It’s like a big puzzle, and if I collect all the vitals and information I need and if I ask all the right questions, I can put it together to form a picture that can explain it all.
I am not a touchy-feely or emotional person. I like rules and structure and logic. So it should come as no surprise that one of the most difficult lessons I had to learn in Veterinary Medicine was how to listen to my gut.
We were in the early evening hours of a Saturday shift when a woman brought her dog in for an “emergency” check-up. (In other words, she just hadn’t taken the time to schedule an appointment, and had enough money that she wasn’t worried about the emergency fee.) The ER was swamped – it was summer, and right around the time when everyone was getting home from the beach or the barbecue and finding that their dog had eaten something it shouldn’t have. It was warm and beautiful outside, and I was stuck only halfway through my 12-hour shift, freezing my butt off in the hospital air conditioning.
“Can someone go triage this dog and send it home,” my coworker hollers. Patience was running thin, and the last thing we needed was yet ANOTHER person using our ER for their walk-in annual exams. “I’m on it,” I reply.
I guide the woman and her dog – a 10-year-old MN Pointer – into an exam room. The woman tells me the dog has slowed down a bit. “How long has this been going on for?” I ask. “Oh, the past year or so, I’d say,” she replies. “I think he has arthritis.” I ask some stock questions while I assess the dog’s vitals. Heart rate, respiratory rate, respiratory effort, mucous membranes, capillary refill time, temperature, and femoral pulses are all within normal limits. Weight is stable. The owner reports no vomiting, diarrhea, acute lethargy, or changes in appetite, water intake, energy, or behavior. All I can get out of her is that he’s “slowing down”.
In my head, I think “You waited a year to come in on Saturday night emergency hours for this?!” Instead, I bite my tongue, explain to the owner that her dog appears stable, and offer her an appointment on Tuesday. The woman declines and insists that since she’s already here, she wants to be seen. I let her know it will be a long wait and that a doctor will be with her as soon as possible.
“Did they make an appointment?” my coworker shouts as I emerge from the hallway of exam rooms. “Nope,” I say as I roll my eyes in obvious annoyance. “Why not?!” she asks with the frustration and exhaustion apparent in her voice. I round her on what’s going on with the dog, then leave the case in her hands as I am already running 20 minutes late to lunch (as usual).
I decide to dedicate my precious lunch break to making a return at the store across the street. As I trek in that direction, I feel my heart start to race and my knees start to shake. I attribute it to the fact that I’ve had coffee and nothing to eat since 10 am and brush it off. However, as I wait in line at the returns desk, I notice I’m sweating – the kind of sweating you do in an interview or when you’re meeting your significant other’s parents for the first time. I shift my shopping bag to my other hand and wipe my damp palm on my scrub pants.
I am no stranger to anxiety, but this is different. I’m getting that sensation you get when your boss says “Can I speak with you in my office?” and you start to panic and wrack your brain trying to figure out what you did and whether or not you’re getting fired. I feel nauseous and I’m thinking about bailing on this line because I’m suddenly feeling desperate for fresh air.
Suddenly, the Pointer comes to mind. THERE’S SOMETHING WRONG WITH THE POINTER. My stomach drops and it all clicks. There’s something wrong with the Pointer and my body knew it before my brain did. I rush to pull my cell phone out of my scrub pocket and call my coworker. “Has the Pointer left?” I hold my breath as I wait for her answer. “No,” she replies with a question mark lingering at the end of her words. “The doctor just went in, why?” I can finally exhale. “Good, ok. I don’t know, I just had a weird feeling, I was gonna ask you to make them stay.”
I hurry back across the street, feet heavy and goosebumps covering my arms. I rush to the break room, where I jump onto the computer and pull up the dog’s medical record. My stomach drops and my teeth clench as I see the title of the SOAP: “Splenic mass.”
Later, I approach the doctor who saw the case to apologize for my failure to triage the patient appropriately. Turns out the doctor had felt the mass on abdominal palpation, then taken the dog for an ultrasound to confirm the location. The mass had not ruptured or started to bleed, and the patient was stable and scheduled for surgery early the next morning. It was all going to be fine, but I couldn’t help but think: What if I had sent that dog home and that mass had ruptured between now and the appointment on Tuesday?
Years later, I still rely on vitals and objective information when I triage pets, but now I also listen to my gut. On more occasions than I care to admit, my gut has been wrong and made me overreact and look like a crazy person who has no idea what she’s doing. But on several occasions, it has also come to my rescue and told me to get a doctor involved immediately even when the normal vitals and BAR presentation are telling me otherwise.
Veterinary Medicine is not just a science, it is an art. If we rely only on facts and figures, we miss out on the power of instinct and intuition, both of which are crucial in the way we practice medicine. I would rather overreact a thousand times than miss one critical patient, so I plan to continue to listen to this gut of mine – It is a tool, just like my calculator or my stethoscope, and learning to use it has made me a significantly better Veterinary Technician.