Winter Break

It's a soggy, cold winter break. But at least I am not in that dreary, windowless classroom. After mulling it over, I decided to work in the emergency vet clinic part-time for the three weeks of the break. I'm working day shifts as a general nurse assistant, helping out whomever needs help. It's a very different pace than night shifts.

The four-day holiday weekend has been particularly difficult, however. As someone remarked on xmas eve (I worked that day), dogs all over the valley are ripping open boxes of chocolate even as we speak. And so it came to pass.

We learned that nearly all the clinics from Eugene to Salem were closed on Saturday, even clinics that might usually be open. I worked 10 hours without a break on Saturday and I'm still a bit shell-shocked. Nearly thirty emergencies walked in the door between 8am and 6pm, and we had only one vet (the emergencies kept coming until 10pm, I was told this morning). He had four nurses and two receptionists, and we made a tight team with good communication, and we co-opted the boarding staff to help even though they were completely full back there too, but some people had to wait a couple of hours before we could get to them. Add to that the regular hourly treatments we had to administer to our ICU patients, which of course grew in number as some of those emergencies had to be admitted, and we were all so busy we could hardly catch our breath.

We treated and released when we could, of course, like the dapple dachshund who, upon being injected with apomorphine, promptly threw up a few pieces of kibble, lots of chocolately goo, and the nearly intact wrappers of the York peppermint patties that she had wolfed down, and the yorkie who decided to nibble a corner off a block of rat bait (the owners brought both the rat bait block and the package label in with the dog)--she refused to throw up for us (stomach of iron, that dog) so she got dosed up with vitamin K and sent home with a three-week supply of vitamin K tablets. Rat bait poisoning is so common that the vitamin K tablets are flavored chewables. (Vitamin K is an essential factor in the clotting cascade; the chemicals in rat bait prevent its synthesis so animals usually die of internal bleeding. A dog that consumes rat bait is given vitamin K for several weeks until we are sure its body is making it on its own again.) And what would a weekend at the emergency clinic be without a lab who swallowed an article of clothing? He neatly and quickly vomited up a pair of socks for us.

Sadly, two animals died under my care. One was a small grey and white hamster. The family, mother, father, two kids, found him unresponsive in his cage and brought him in. He went into heart failure while the doctor was examining him in the treatment area so the doctor jabbed epinephrine into his heart while I was pumping his chest in an approximation of CPR. His little ribs were so fragile but you still have to push hard enough to force blood in and out of his heart. The hamster's heart started again but the beat was weak and thready. Doc told me to pack some warmies around him and wait. In the meantime, I had to go into the room with the family to complete the history on the computer system. When we have severe emergencies like that, we often begin treatment with only a verbal agreement from the owner and finish the necessary info gathering later. The kids were sobbing and the mother was crying as she was telling me what had happened. I'm thinking, the animal is probably already dead, but I couldn't tell them that. I finished up and checked on the hamster. Neither I nor the doctor could hear a heartbeat. I closed the hamster back up in the blanket and warmies. The doctor finished up a phone call then headed back to the room to talk to the family. I checked on the hamster again--and he was alive. I said, shit, he's alive! Get the doctor! A nurse launched herself down the hall, grabbed the doc. He came rushing back and we set the hamster up on oxygen with his entire head in the smallest mask we have. The hamster's heartbeat never stabilized however. The doctor talked to the family, returned, and told me to draw up the phenobarbitol solution that we use for euthanasias. When I brought the hamster in to them, the girl was very upset, and the little boy was sad but also fascinated to see his former pet in this changed state. I escorted them out the side door--our lobby was packed with people waiting to see us and I thought it best for everybody if the family had a more discreet exit.

The second patient was a King Charles spaniel, an older rescue. He was in an incubator with oxygen and had a tube stapled to his head feeding oxygen directly into his nose. He had heart disease, some combination of congestive heart failure and a mechanical problem--he had a distinct murmur. He had an IV catheter but wasn't on a huge pile of drugs. We had pushed small wires through his skin in three places to attach ECG leads. They can be placed directly on skin but the clips slip off pretty easily and we wanted continuous monitoring. Around 5pm, I untangled the ECG cords so I could weigh him. As I lifted him from the incubator, I noticed he was limp. I saw his tongue had turned blue and just then he started to code--wildly irregular heartbeat, gasping for breath. I called the doc for what seemed the thousandth time that day while drawing up epinephrine for the dog. We gave the dog two epinephrine injections and another of atropine. His heart stabilized but the beat remained thready and weak. The doctor called the owner, thinking the dog might hold on until they could get to the clinic. But while he was on the phone to them, the dog's heart stopped. Despite additional resuscitation efforts, we never got it started again.

It was a trying day but doing that kind of veterinary nursing gives me exposure to an incredible array of clinical problems and solutions. We are covering cardiology in physiology next term. There's the lecture then there's the application in the clinic. I'm not working during the break for the money, although it is helpful, but for the experience.