Tuesday, May 17, 2011

Why I love and don't love my job

It seems like everyone wants to or had wanted to or knows someone who wants to be a vet. I admit, it does sound like a cool and glamorous job. Lisa or I get asked to speak at our kids' elementary school at least twice a year on veterinary medicine as a career. We are very popular with this age group! Of course, as kindergarteners mature to tweens, then go off to college, vet med loses its allure. In some cases, people realize they don't have the desire or aptitude for all of the science and math involved in the schooling, or they don't want to go to school for the 7-8 years required to earn a vet degree. Others figure out that the vet field isn't all about playing with puppies and kittens, or working in the quaint English countryside a la James Herriott. And of course, many come to the realization (hopefully sooner rather than later) that's they won't make as much money as a vet compared with other science degrees.

However, I am one of the few who stuck with it. I did actually want to be a vet for as long as I can remember and my career path never strayed. I pushed through with a bachelor's degree in biology, then right into vet school in the fall, earning my doctorate of veterinary medicine degree in 1996. No regrets, except maybe I could have slowed down a little when I was younger and not been quite so career-driven. Maybe should have taken a year off the explore the world or something.

Anyway, 15 years later, I still mostly love what I do for a living. And the beauty of this profession is that if I didn't like small animal practice, I am fully licensed to work on any other species of animal, or work in research, government, shelter medicine, or I can do a residency and become a specialist... well you get the picture.

One of the things I like, and don't like, about my job is that I never know what's going to be coming through the door next. Take last Friday, for instance. It was a fairly busy day, but not overwhelming. Most of the cases I saw were fairly routine - wellness exams, ear infections, diarrhea. However, my last appointment of the afternoon was a 13 year old terrier with, as the owner describe on the phone, bloody stools. However, when she came in, she was actually bleeding from her mouth, and quite heavily. I would estimate at least a drop a second of bright red (read arterial) blood. This had been going on for a couple of hours, and a 20 pound dog can't keep up that blood loss for long. I was able to localize the bleeding to a small area in her gums just above her largest premolar tooth, but I could see no wound, tumor, or evidence of a tooth abscess. Her STAT cbc and profile was normal except for anemia. I submitted a clotting panel, which would not be back until the next day. Short of referral, the owner's only choice was to have me anesthetize her to explore the area, take dental x-rays to check for a tooth abscess, and possibly extract a tooth. I warned him that she could die even during the procedure if I couldn't stop the blood loss. After some consideration (and discussion with his wife), the owner gave me the go-ahead.

We started this dog on IV fluids and at about 4 pm (the time I and a large part of my staff are supposed to leave for the day) we gave her a pre-anesthetic injection. She immediately collapsed and her heartrate dropped to about 30 beats per minute with a marked arrhythmia. And her gums became very pale. I was very concerned that we were about to lose her, but I reversed one of the anesthetic agents and gave her atropine to increase her heartrate, and she slowly improved. Whew!

The good news now is that (perhaps because her blood pressure also dropped so low), the bleeding stopped. I took several dental x-rays but could not clearly identify an abscess or a tumor. She did have deep pockets around two teeth in the area, so I went ahead and extracted the two teeth. This is a job in itself - both teeth have 3 large roots each, and it took about 30 minutes and a lot of drilling to fully do the job. It appeared that she did have a fisula, or communication between the mouth and nasal cavity at one of the roots, making an abscess a likely diagnosis. I sutured up the gum tissue and also biopsied a tumor she had near her anus for good measure. She woke unevenfully and was sent home on antibiotics, pain medication, vitamin K (in case she had a clotting issue), and I gave the owner my cell phone number in case he had any concerns. I sleep a whole lot better if I know that I will be called if there is a problem.

Cases like this, where I get to use my brain to try to figure out the problem, as well as my surgical skills to fix it, are what I really love about my job. However, I left the clinic at around 6 pm, two hours later than I was supposed to leave. That's one thing I don't love about it. Many times (statistically it seems Fridays are the worst for this) I have stayed late to perform an emergency surgery. Or worked over my lunch hour. Or took a patient home with me for monitoring. The kids are cute when I bring a patient home and set it up in our bathtub with a fluid pump. The girls are always "visiting" the pet, or trying to help me with treatments. I don't get much sleep those nights either because I am always listening for the fluid pump to go off.

Anyway, the patient from Friday came back the next day for a recheck and she was doing great. Her clotting panel also came back normal, so I suspect that a tooth abscess had eroded into a large artery in the roof of her mouth. Not many people can say they saved a life on a given day.

I can.

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