DrAndyRoark.com

Articles, Videos, & Training on Pets & Veterinary Medicine

Life With Clients

My Mistake Killed My Cat

by

Last week I experienced the worst day of my career. Actually, it rivals the worst day of my life.

It was my first week back from vacation. My old kitty, Meow Meow, had been in boarding during the holidays. When I got her home, she didn’t seem quite right. She wasn’t eating or drinking very well for a couple of days, and she was weirdly clingy. Although I chalked it up to stress, I decided to bring her into the hospital for blood work and IV fluids.

It was an unusually slow morning. Technicians and assistants were puttering around, chatting. There was only one extensive dental procedure lined up, so I decided to get the ball rolling with Meow Meow. I examined her, drew blood, collected urine, and placed an IV catheter. I asked one of our technicians to prepare a bag of LRS. She hung up the bag, and proceeded to get a cage ready. I looked up to see a full bag of LRS, with fluid sitting in the drip chamber, all ready to go; or so I thought. I grabbed the line which had been draped over the hook, connected it to her port, and opened the crank. Something wasn’t right about the way it dripped; I looked at the technician holding Meow Meow and we realized simultaneously, the line wasn’t primed. She swiftly pulled it out, but it was too late. Meow Meow got a line full of air. She died. Almost instantly. CPR failed. Her tiny little body couldn’t survive that.

I was shattered. I screamed and wailed over her dead body in the treatment room. How could this have happened? How could a bag have been spiked, a drip chamber filled, and the line not primed? Why didn’t I check it? Why MY cat? Why didn’t I get that bag ready myself, as I normally do? Why did I bring her in? I should have left her at home. She probably would have been fine.

My husband and I took her to the crematorium. I cried for a long while, clutching her wee body tightly in my arms. I apologized to her for allowing this mistake to happen, to take her life. I thanked her for all the joy she brought me through the years and hoped that she enjoyed her life with us.

I took a couple of days off work to grieve and lament. I requested the owners of the practice call a meeting to review protocol; to remind the team that careless medical practice is a recipe for disaster; to bring some justice for Meow Meow. I came back to find out that nothing was said or done. Instead, it was swept under the rug, like so many other things have been in the past. Oh, and Meow Meow’s test results were normal too.

Meow Meow died because of sloppy work. I wish I could tell you there was a reason this distraction occurred; that we were super busy and it happened in a moment of chaos. However, there is absolutely no excuse for it.

It is my hope that in sharing this story, I can remind those in the veterinary community that vigilance must always be practiced. Systems must be in place to prevent errors. We must always check each other’s work. We must constantly remind ourselves that this is serious work, as lives are hanging in the balance. We can do better. Some of us need this reminder more than others.

It is my hope that Meow Meow’s story will save a life.

Editor’s Note: This piece broke my heart, as a pet lover and as a colleague. The author’s admonition to learn from her mistakes is a loving testament to her beloved pet. I also hope as a community we know the importance of being gentle with ourselves when mistakes happen, which they, unfortunately, do to us all. 

These Are My Thoughts When I Lose a Patient

by

Yesterday I lost a patient. I wasn’t even there.

It all started last week.  He came in for vomiting.  His x-rays were inconclusive. We decided to treat him symptomatically with IV fluids and repeat radiographs. They were still inconclusive, but the vomiting had stopped and he was eating and acting normally.  We sent him home.

The next day, he vomited again.  He came back in for an ultrasound. From ultrasound, he went to the OR.

He had adhesions from another surgery years ago—scar tissue—that had resulted in an obstruction. I couldn’t safely break them down, so I had to remove a section of intestine.  The two healthy ends of bowel came together nicely.  I checked the incision for leaks and finding none, I closed him up.

The next morning he was eating great and acting normally.  The day after that he was fine too.  On the third day, he wasn’t.

“We have to go back in,” I told his Dad.  “The incision could be leaking.”

I hoped I was wrong.  I wasn’t.

We removed more intestine and repaired the anastomoses.  We flushed his abdomen with sterile saline to try to clean out any bacteria or ingesta that had escaped the GI tract.  We loaded him up with antibiotics.  We crossed our fingers and prayed.

He made it through the night but the next morning he still couldn’t sit up and his protein levels had dropped dangerously low.  I wasn’t there, but I called my colleague to confer on the case.  He needed a plasma transfusion, we decided.

He never got it.  While the fresh frozen plasma was defrosting, he decompensated.  They did CPR, but he died anyway.

I’ve been through it a hundred different ways since that morning two days ago when it all went south.  What could I have done differently? Did I do something wrong?  Was it my fault?

14. That’s the percent of dogs undergoing this particular surgery that encounter this complication. Not the percent of my patients—just what the retrospective studies show.  And adhesions increase the risk.

This should make me feel better, but it doesn’t.  Because he’s still dead, and I’m still left wondering.  Was it fate, or was it me?

I know I did everything I could.  I know I’m a good surgeon.  I know this happens to the best surgeons.  But it doesn’t matter because I still can’t stop wondering.  Would he be alive if another doctor had done the surgery?  Was it my suturing technique?  Was it my choice of suture material?  Was it my tissue handling?  Was it me?

Clients often think euthanasia must be the hardest part of my job.  It’s not.  This is.  The ones we try to save.  The ones we give our all to.  The ones who have a chance but die anyway.  That’s the worst part of the job.  It makes us doubt ourselves.  It makes us feel helpless and useless.  It makes us feel like failures.  These are the cases that you never truly get over.

Sure, the wounds will heal, but they will leave scars.  Adhesions will form.  And you can never cut them out or break them down.  They will sit there for years, not really causing a problem, until one day something gets stuck in our tangled web of emotions and the old wounds feel fresh again.

We will heal for our patients who won’t, but we will never be whole.

The views and opinions expressed in this article are those of the author and do not necessarily reflect the position of the DrAndyRoark.com editorial team.

How I Respond Every Time a Dog Hurts a Child

by

Any time I hear of a dog injuring or killing a child, my heart breaks. As a human, it breaks for the child, who has either been physically and emotionally scarred or taken from this earth far too early.

As a mother, it breaks for the child’s family to see their child endure such a trauma. As a veterinary professional, it breaks for the dog.

“Wait…” you say… “but the dog is to blame for this horrible act. Why should we feel bad for the dog?” My response is always “Why did the dog feel it needed to act this way?”

A recent report of two dogs fatally mauling a young boy in Massachusetts has me once again advocating for the dogs, while everyone else is carrying their pitchforks and calling for legislation.

The details have not been confirmed, but this little boy had found himself inside of the fenced-in area where these two neighborhood dogs were confined. Unfortunately, one of the dogs was euthanized, while the second is in custody.

As a mother to a young boy, I cannot imagine the heartbreak that his family is going through. I do not negate that a child’s life was tragically and horrifically lost. However, let’s take both the dogs and the child out of the picture.

A human trespassed onto someone else’s property.

If this was an adult, they would be arrested or threatened by the homeowner. Let’s add the dogs back into the story. A human trespassed onto someone else’s property and was attacked by the homeowner’s dogs.

In this story the dogs may be considered heroes, simply protecting their owner and their property. Now make the trespasser a child. Suddenly the dogs are murderers, dangerous, and should be euthanized. Their entire breed should be banned. How does this leap happen?

“Well, children don’t know any better. You can’t possibly blame the child for a vicious dog’s behavior!”

How is it that a 7-year-old does not know that you need permission to be on someone else’s property? Or that if you don’t know a dog, you shouldn’t approach them without permission?

According to Stopthe77.com, roughly 77% of dog bites are from a family or friend’s dog. Which means that 77% of dog bites come from dogs that children KNOW.

This tells me that there is a severe lack of education on how children should be interacting with the family pet. If they don’t know how to interact with a dog that their family deems as friendly and tolerant, then how are they expected to know how to approach a strange dog?

Watch any montage of “cute” dog and kid videos and you’ll see dogs who give so many signals that they are uncomfortable. The parents and family taking these videos aren’t malicious – they don’t WANT these children hurt. However, if they knew how to read their dog’s body language they would put the camera down and intervene.

These situations are so easily preventable. As someone who loves dogs, who works with them daily and has taken the time to educate myself on their behavior I urge parents to TEACH their children.

Take some of the blame off of the dogs. They only know how to survive and protect themselves. They don’t speak our language and we can’t teach them to. So that puts the responsibility on US to learn how to speak theirs.

Stop calling for bans on specific breeds. It’s not the dog’s fault. ANY dog can bite; small dogs, large dogs, lazy dogs, old dogs and young dogs. Should a known aggressive dog who is a true public safety risk be humanely euthanized? Absolutely.

Should a whole breed of dogs be banned from knowing what it’s like to be loved, pampered, trained and properly socialized because we’re too selfish and full of ourselves to see past their looks and learn how to communicate? Absolutely not.

The views and opinions expressed in this article are those of the author and do not necessarily reflect the position of the DrAndyRoark.com editorial team.

MaryanneAldrichPicAbout the Author

Maryanne Aldrich is a Veterinary Assistant at PawSteps Veterinary Center in Northbridge, MA. She graduated with an Associates Degree in Animal Care from Becker College and began working at PawSteps in the spring of 2013. She developed an interest in animal behavior early in her career and has continued to improve her understanding of veterinary patients through self-study, consultations with other professionals, and formal continuing education courses . She regularly advises clients about home behavior care and has successfully implemented programs at PawSteps to provide less stressful veterinary experiences. The mother of two tiny humans, and a chocolate lab named Abbie, Maryanne understands the importance of educating clients and their families on how to “read dog” and is passionate about setting new puppy parents up for a lifetime of success.

What a Puddle of Pee Taught Me About Trust

by

“Uh oh!” I look to my right, and a distressed stranger is pointing at the ground next to me.

I’m standing at the front desk of a veterinary clinic, so I look down cautiously. (You never know what could be on the ground at a hospital, and I am admittedly only cut out for the business side of vet med).

There is a river of dog urine closing in on my favorite suede booties. It’s coming from my friend’s senior Weimaraner, Callie.

“Oh my God. I don’t know her,” I joke, shooting my friend my best judgmental look. (Obviously, my dog never does anything embarrassing).

My friend, however, is completely mortified. “SHE NEVER DOES THIS! I AM SO SORRY! CAN I CLEAN IT?” she exclaims.

The customer service representative stares at her blankly. “I mean, there’s paper towels over there.” She motions to a station across the store, and my friend obeys the direction.

Unfortunately, there are about 2 towels left on the roll, and we are dealing with a 60-pound dog amount of pee.

“Kind of seems like a mop situation. Callie really committed to this,” I say to the customer service representative as two more appear behind the desk. More blank stares. As a former practice manager, my head starts to slowly spin. How are they not getting that they should offer to help?

“Well, there are probably more paper towels at another one of the cleaning stations,” the CSR finally suggests. My friend dutifully ventures off to find them while I try to go to a zen place in my mind.

“Not my practice, not my staff, not my problem,” I repeat over and over in my head. I wonder if I’m overreacting, or if my friend is as horrified as I am by the team’s response.

We move on to the exam room, where my friend expresses her concern about the public urination incident to the veterinary technician. She isn’t communicating that she’s upset about cleaning it up. Instead, you can tell she’s worried something is wrong with her aging dog.

“Ya, we’ll check her bladder when we bring her in the back,” the veterinary technician responds. My Wendy Meyers fandom makes me cringe at the term “the back”, but I’m even more concerned about the general lack of concern for my friend’s feelings. Again, I wonder if I’m overreacting.

Callie gets admitted to the hospital, and my friend and I return to the car to debrief.

“They really weren’t very compassionate, huh? It makes me wonder if they’re, like, going to yell at her if she barks while she’s there or something.”

And this is when I realized this is more about a puddle of pee coming dangerously close to my beloved Steve Madden boots. It’s about trust.

My friend felt embarrassed about her dog’s accident, and no one reassured her. She felt concerned about her dog’s unusual behavior, and no one comforted her.

Callie might receive the best possible medical care while admitted at that practice, but my friend’s trust has been lost. No matter how good your medicine is, remember that building trust can start with simply mopping a pee puddle.

The views and opinions expressed in this article are those of the author and do not necessarily reflect the position of the DrAndyRoark.com editorial team.

Danielle K. Lambert Archer headshotDanielle K. Lambert is a former veterinary practice manager and the founder of SnoutSchool.com, a website dedicated to teaching veterinary hospitals to use social media effectively. You can get her 5 favorite social media tools here, or follow her on social media to see excessive photos of her Brussels Griffon. She’s @DanielleSnout on Snapchat, Instagram & Twitter.

Are You Feeding the Wolves of Vet Med?

by

One story circling social media is “The Story of Two Wolves.” In this story, a boy walks with an elder and begins telling of a struggle. Two wolves are fighting within him. The first wolf is made up of all negative emotions; anger, hate, ego, and maliciousness.

The second wolf encompasses positive emotion; love, kindness, compassion and empathy. The boy asks his elder which wolf will survive. The elder simply replies, “The one you feed.”

Deep stuff right there. A wonderful story to remind us that our energy contributes to our emotions. But if you’re not into philosophical musings because you are busy in real life, I would like to break this down for you.

These wolves do not just represent our human emotions. They represent small situations we deal with every day. The evil wolves of vet med can be an angry client, coworkers who treat you like crap, 1-star ratings, or a toxic environment.

The good wolf is the client who brings you donuts, the parvo puppy going home after hospitalization, a coworker who teaches you or learning something new. Any life situation or clinic situation has their own versions of evil and good.

So now let’s talk about feeding them. We’ve all had our victories. Seeing a patient who was critically ill respond to treatment walk out the door is one of the most amazing feelings in the world. In those moments we feel like we created magic and our faith in goodness is restored. But it’s fleeting at times.

We experience it and then we move on. We talk to our family about it with dinner. But then the day ends, and we forget about it to a degree.

We all have that one client. The one who doesn’t want to comply with recommendations and is downright rude to the staff. A client who seems to enjoy talking down to others and completely ignoring any attempt to help their pet. The client who gets the team in a tizzy and then staff needs to vent. So, they talk about how awful this person is or how rude they are. And then, one more staff member joins in and then another.

Now we have a full-on venting session that has taken up a huge chunk of our time and no one has left feeling any better.

What wolf do you feed? Do you feed the wolf who encourages, is kind or makes you realize you have the best job in the world? Or do you feed the wolf who leaves you feeling angry, irritated and losing your faith in humanity? Which one do you talk about more? Who do you think of when your head hits the pillow at night?

When we deal with these wolves, it is so important to remember that we get to choose how we feel. We can look at our victories, our amazing work, or our little moments of happiness. Or we can focus on the inconveniences and problems we deal with every day.

We choose where we invest our energy and where we invest it is important in getting through this crazy world of vet med. The battle will always be there.  Look for your blessings and remember that we determine what wolf lives in us.

The views and opinions expressed in this article are those of the author and do not necessarily reflect the position of the DrAndyRoark.com editorial team.

Why Compartmentalization Should Be a Regular Habit

by

“You’re always so happy, how do you do it?” the client asked me as I examined her dog.

“Good acting,” I half-quipped. This day in particular had me believing my happy face was nothing more than a ruse.

It had been a tough week and an even tougher day. Our four (looking for a fifth) doctor practice was down a doc again as we had been for six of the previous eight weeks, a cat I had seen for a UTI had died unexpectedly at home, my parents’ dog was in end-stage kidney failure, and I had spent 15 minutes on the phone with an irate client who believed I was personally responsible for her dog tearing her cruciate while she was boarding.

I was on the verge of a nervous breakdown. How could I go into an exam room with a smile on and pretend everything was alright?

Compartmentalization.

In that exam room, for those few minutes, I was happy. I was with a client who loved her pets and was always kind and appreciative of my efforts to care for them. She had recently lost one of her dogs, but here she was with a newly adopted senior dachshund she had opened her heart to. I was happy for her. So I left everything else at the door.

Compartmentalization is how we focus on explaining atopy to one client while worrying about the CHF dog in oxygen in the back. It’s how we kindly and genuinely greet one client right after getting reamed out about charges by another.

And it’s how we go home at the end of a 12-hour shift filled with emergencies and still manage to enjoy a good snuggle with our own pets. Compartmentalization is how we stay sane. So how do we do it in a healthy way?

Leave Work at Work

We all do it. We bring a chart home to write up. We research a case on VIN from our house. We stay up all night worrying about our splenectomy from that morning. We don’t give ourselves a break and that is a recipe for burnout.

Start the process of disconnecting from work before you leave the office. Make sure your calls are made, your charts are written up and your in-patients checked on. Then tell yourself you’re leaving. Make it a mantra. “Goodbye vet med.” “Lauren has left the building.” “Peace out, pets.” Saying the same thing every time tells your brain to start shutting down.

The mental shutdown may take a while. Allow yourself to process the day on the commute, but once you’re out of the car, work is over. When you start thinking about work again, remind yourself that it can wait until tomorrow. Your patients are safe with their families or the next doctor on shift. Your clients have the number for the local emergency clinic. It’s okay to stop thinking about work for a while. You are not a horrible person if you take time for yourself.

Focus on One Thing at a Time

Multi-tasking has become an integral part of life, but it’s not always good for you or your patients. It may feel ingenuine to go from a euthanasia to a new kitten exam and act all ooey-gooey, gushing over the cuteness. It’s not. That kitten and her family deserve your enthusiasm as much as the family euthanizing their dog deserves your empathy.

When it’s time to move from one room to another, step into a neutral place. Close your eyes, take a deep breath, and tap into the energy that you’re going to need for the next appointment. Once you’ve made the change, move on to the next room and focus all your energy on the new task at hand.

Don’t Ignore the Bad Stuff

It’s not healthy or helpful to spend all your time obsessing over a case that went bad, a client that blamed you for something that wasn’t your fault or a bad review. Learn to shut it off—but not forever. The really bad stuff needs to be processed. You need people you can talk to about it and a time and place to analyze it where it won’t interfere with the rest of your life.

Repressing the difficult stuff only internalizes the pain. Trying to push through and ignore it is one of the risk factors for developing compassion fatigue. So if you have a compartment that feels especially heavy make sure you make time to open it up and lighten the load.

Learn to Say “No”

We hate hearing it almost as much as we hate saying it. We feel like we have to do it all. But we can’t.

We only have room for so many compartments at once. That means we need to decide what the most important things are, carve out a place for each, and say “no” to the rest.

If one compartment is for going to the gym after work, then when someone calls at the last minute asking you to see their dog with an ear infection, the answer is “no” because you need to get out on time. When you’ve made a compartment for Saturday with the family and a colleague asks you to cover their shift, the answer is “no” because you already have plans. And for all that is good in this world—PLEASE don’t give your cell phone number to clients to call you at all hours. A decent night’s sleep is essential for processing all the events of a day and waking up ready to do it all again.

Compartmentalization generally has a negative connotation, but the truth is, sometimes it’s necessary. It’s a tool we need to survive, to create a balance in our lives, and to give ourselves permission to enjoy the good things in life.

The views and opinions expressed in this article are those of the author and do not necessarily reflect the position of the DrAndyRoark.com editorial team.