A Hard Day's Night

My apologies to the Fab Four.

WARNING: There are some upsetting photos at the end of this post. I am going to put them below a fold. But if you click through, you will be exposed to them.
 
My job as a night vet tech in the big ER vet clinic is proving to be challenging and rewarding in almost equal measures. Blood, feces, urine, vomit, survival, recovery, death, birth--it's a hell of a tapestry. I used to suffer from insomnia. Not this summer! I am asleep as soon as I become horizontal, sometimes even before then: the other afternoon I nodded off while playing a last game of baby with the dogs before we went to bed--they were not amused.

But don't let my whining mislead you--I am learning so many valuable things! Every night I am confronted with situations that require me to step up to the plate, that require me to act with compassion and confidence. Every night I get a little more confident that I can do that. 



The job of a vet tech overlaps with that of the vet but they serve different functions with respect to patients and owners. For example, the vet may order a CBC blood panel for a patient. He may not know (or remember, or even care) which tube we need to put the blood in for this test, whether we are running the test on serum, plasma, or whole blood, and he certainly doesn't care which machine is used or which buttons must be pushed in which order to make the machine do its thing. That is all the job of the vet tech. The role of the vet is to identify when that test will give him useful information about the animal's condition and to interpret the results when we hand them over. 

I've learned that the vet tech is another important "test" that the vet can use: we have our hands and eyes and ears on an animal far more frequently than he does. A good vet will use his techs to identify subtle changes in physical state or behavior or demeanor that he might miss. Communication is essential here. Not just the style but the content, timing, and mode of delivery. 

The vets that I work with can sometimes be kind of crabby at 3am when faced with the fourth bloat of the night (they work 24-hour shifts on the weekends) but without fail, they are willing to answer my questions and give me more information when I need it to execute their requests. In return, I give them my entire focus: they want hustle, they get it. They want to see the dog we just had out 5 minutes ago, they get it. At 5am they call down and change all the meds they had scheduled for a patient at 2am, I update the flow sheet. Apparently I boasted (quite foolishly) when I started working at the clinic that I only had to be shown something once. One of the vets I work with regularly remembered that and repeated it to the clinic owner, affirming to him that it was true; he repeated it all back to me. She's a vet who relies on her techs to do their job so she can do hers; I was extremely pleased.

Having said all that, let me show you a different perspective. Take a look at this blog post. Go on, I'll wait.

Where do we start with that mess? I started by showing it to vets and techs that I work with. I asked them if the experience of the vet writing that blog was similar to theirs. Their responses were consistent: she needs to find another job, preferably not doing veterinary medicine. Here are our combined comments:

• Quit giving free vet advice to "friends" on Facebook. No, better yet, get the hell off FB entirely.
• Draw clear lines between home life and professional life. 
• Find another clinic to work for. Any clinic that double-books is not a clinic that is focused on patient care. Our clinic may schedule 2-3 wellness appointments back to back for a single daytime doctor (not overlapping) but those are immediately followed by a block of time, usually 10 minutes per appointment, so the vet can take care of notes and calling owners. Every single daytime vet at the clinic that I work at has a scheduled lunch hour.
• Fire the techs at that clinic and find ones who can do the job. A vet collecting xrays for a barium study? That's what a tech is for. 
• If you can't fire the techs, learn how to use the techs you have rather than do it all yourself. Compassionate, patient-focused veterinary care requires a team, not a lone ranger here to save the day. 

"Harsh reality"? I beg to differ. There are many ways to run a clinic: some ways result in patient-focused care, others don't. That vet blogger should come visit our clinic. Just not at night. She couldn't handle it.

A large dog came in with a history of seizures. She became frantic in her kennel and pulled the T-port out of her catheter. We were checking on her every half-hour because of her high anxiety level. This looks horrible but it really isn't very much blood. Note the bloody paw prints on the floor, the blood droplets on the walls, and the bloody paw smears high up on the door. We calmly flushed her line and her catheter, re-taped the T-port more securely, cleaned up her paws, and moved her to a new kennel. I drew the short straw and had to clean this up. She eventually calmed down and went home later the next day with some different seizure meds.

I think someone tried to unsuccessfully lop this cat's head off with a sword. The muscles holding its scapula to its spine are severed. The wound is glistening with sterile lubricant that we put on. The severed muscles are severed permanently. But the laceration was repaired, the cat spent a couple of days with us, and eventually went home to a new life as a full-time indoor kitty.

A pregnant mini Aussi came in after nearly 12 hours of labor but no puppies. The owners had no idea how many puppies there were. We did a quick xray: four puppies in the uterus but her vaginal canal was clearly far too small to accommodate them. We quickly, and I mean quickly, prepped her for surgery: C-section and spay. The other tech monitored vital signs and I got to catch puppies as the vet pulled them out. I had to open their sacs, clean their airways, rub them dry, tie off their placentas (I used leftover sutures when the doc was sewing mom up), and try to keep them warm and breathing. One of them stopped breathing and I went into tiny puppy slapping mode. He decided to rejoin us after a frantic 30 seconds. A couple of hours after surgery (mom got very little in the way of sedatives because all the common drugs cross the placental barrier so she woke up "rough"), all four pups were nursing vigorously and mom was doing fine. They went home that morning. They were adorable.

One of the tasks of a vet tech is to prep various areas of the clinic. Surgical instruments have to be scrubbed with Dawn dish soap, put in the ultrasound, put in the "instrument milk", a creepy white instrument lubricant, left to air dry, then gathered into packs. Each pack has a specific purpose and thus its own array of instruments (we have a binder that describes the contents of each pack and the instruments have colored tape on them to identify which pack they belong in). The gowns and towels the doctors wear have to be laundered then packed too. Packing means wrapping the instruments in a very specific manner into a green surgical wrap, folded in a very specific manner, then wrapped again in a second green surgical wrap, also folded in a very specific manner. Then the packs go into the autoclave for final sterilization. If you leave out a key instrument or fold the gown wrong, the surgical theater can go wrong very quickly. I am being trained on making packs. These are the two best ones I've made so far. Doctors only care that the packs contain the instruments they are expecting and that all contents are sterile. They don't care that I had to refold my first pack four times ("That sucks, do it again." I love my co-workers.) before I was allowed to proceed to the next one. We do this kind of thing in between emergencies.

A 3.4-pound poodle challenged a deer. The poodle lost. The deer kicked it, lacerating its belly. That's a couple of loops of its intestines hanging out, draped over its leg. The owner drove two hours to get to the clinic with this dog wrapped up in a towel on her lap. She was amazingly calm when she arrived. The dog lost a bit of its colon during the repair but it survived and when home about a day later. He was an adorable little speck of a dog.