Reader opinions wanted!

First, I want to say thank you to all the wonderful readers who comment on my posts. I have received heartfelt, supportive, insightful, constructive and empathetic comments and messages…and on difficult days, these notes easily become the most encouraging and inspiring part of my day.

Thank you!

As much as I ramble, rant and randomly post about the various aspects of vet life…I am curious what readers would like to hear more about? So I created this little poll, just to gather some feedback and help take this blog in different directions.


Out of the Woods – Creepy Farm Call #1

In the spirit of Halloween, I was thinking back to some of the more creepy farm calls I’ve been on in the two years. I definitely place this one in the top 5, but certainly isn’t the scariest or eeriest story by far. Saving that story for a future post.


Last June, I was sent out on a very remote farm call…almost an hour into the middle of the woods. Our appointments in google calendar were also linked with Google maps, so that navigating to the next call was automatic. I rarely entered in or checked a destination address. I passed through a couple neighboring towns, and then through small “ghost towns” …old wooden buildings with the planking peeling away and paint long gone, old decrepid cars with all the tires flat. If listed, town population signs never sported a number over 300.

Cell service became intermittent, and then non-existent once I turned off the highway onto a paved road. After 15 minutes, the paved road turned to gravel, and after passing a ntional forest sign, I started passing foresty service roads. After 30 minutes, I still hadn’t passed a single house as I wound down through a valley along a wide, fast-paced river.

The appointment was for a feral, lame horse. The horse had already received 2 tubes of dorm gel prior to my arrival. I had tried to find this place before, but after an hour of searching, called it quits. We arranged for one of the owners to meet me today, the spot I quickly approached (a Y in the gravel road with a tree inbetween the forked paths). He waiting there in a weathered mid 80’s ford truck. He had already turned around to servce as the pilot car, and a plume of exhaust fumes serged up from where the exhaust pipe would’ve been.

We didn’t pass a single house, driveway or other sign of residence. Gated and overgrown logging roads intersected the gravel road, which wound deeper and deeper into what I presume, was still national foret land. The gravel road faded to dirt road, and as we came around a sharp corner, his truck suddenly disappeared from sight. I hit my breaks to see his exhaust plum leading my like an obnoxious bread crumb trail. He veered down a dirt path, certainly no road. An assortment of dust-laden vegetation crept far enough over the path to make it invisible. I remember thinking they didn’t have a mailbox, and that I was probably coming up on a squatter compound…but squatters or not, they had a horse that was severely lame.


The truck stopped at a widening of the dirt path, and then pulled away to park amongst an assortment of rusty, scrapped and stripped cars, trucks and vans. Dispersed beyond the cars, amongst heavy tree trunks with low lying branches, were 5 large tents. Picture safari-style hunting tents…aged, mossy, holed and sagging canvas between the frames. Beyond the tents, a small paddock was built with an assortment of scrap metal, poles, logs and other makeshift materials. The guy said nothing and disappeared into a tent. All the tents had ventilation through welded pipes, the canvas material cut to give the steaming pipes a wide bearth.

An older woman was standing with the horse, and motioned for me to come over. I got out the basic tote, head lamp and wandered through the brush to the coral. The horse’s hooves were overgrown to the point of making 6 inch long skis, with the toes almost curling back like elf shoes. With the horse sedated, I could complete my exam and figured the lameness was a result of the unmanaged toe length and laminitis. It was while I was discussing this with the owner that I motion caught my eye. From all directions in the woods, coming around and between massive tree trunks, people slowly emerged. Men and women, ranging from (my guess) early 30s to mid 60s, silently made their way out of the woods. Some of them didn’t seem to notice I was there, others shot furtive glances. One by one they disappeared into various tents. If any of them spoke a word, I certainly didn’t hear it.

My heart was racing at this point, and I felt vulnerable and exposed. The only thing I could think to say was that I was going to grab my phone from the truck (not that it had cell service or would do any good). I got to the cab and grabbed the only real defense weapon I had. It was a can of mace my friend had gotten me after I was attacked by a farm dog a couple months earlir. As I was returning, one of the flaps to the tent was flapped back. Inside, there were large burn-barrel with lids…5 or six with pipping going towards what I assume isthe main pipe coming out the top of the tent. I glanced to make sure the vet bed was closed, ie locked. It was.

As I finished discussing my recommendations, the various tatter-clothed people emerged from the tents one by one. They randomly accumulated around the bed of the vet truck, looking it over curiously. They were 5-10 feet away from the truck, inspecting it and ocassionally me. I confirmed no cell service, and never wanted a distress beacon so badly in my life.

The owner went to retrieve her checkbook while I settled into the truck. Like every time your heart is pounding, pulse bounding, adrenaline serging…minutes in panicked reality feel like hours. This situation, no different. I sat there, on the verge of fleeing but forcing myself to wait. No one said a word amongst the six or seven scraggly, barefoot men that lingered around the truck. Women arrived, check in hand, and and said the guy who brought me here was just turning his truck around to show me the way back.

$%@$ that, I thought. No people or cars were behind me, and all I could manage to say cooly through the cracked window was “I’m good.”

I didn’t know that little ford vet truck could go so fast in reverse, and I’ve certainly never driven in reverse that fast for that long in my life.


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Logistics Behind Ambulatory Work, Part II: Drive Time

I receive quite a few questions from ride alongs, job shadows, students and clients about the ambulatory component of work as a mobile equine vet. I decided to share some of my experiences and insight by answering some of the most common questions I get. In Part I, I discussed some of the logistics behind scheduling, navigating and billing for our practice.

The next series of questions I am frequently asked include:

  • How much time do you spend in the car on average per day?
  • What is the longest you’ve ever driven to one place?
  • What do you do in the car all day?

 

Drive Time

Google Map’s timeline is an invaluable resource for tracking how much time we spending getting from point A to point B, tracking mileage, tracking the time spent at each farm call and overall time spent driving per day. All this data is arranged in a calendar mode, meaning I can pick any day of the month and retrace my route.
The season and whether or not I am on call are large factors in the amount of time I spend in the car. I went back and reviewed my timelines from different months to get an idea of variation between seasons.

Our slow season is November-March, so I chose to review the month of January. For the month of January, drive time was 2-3 hours per day with 2-3 farm calls (1-2 hours were spent at each farm call). My on-call days with emergencies increased the average number of hours to 4, with 1-2 farm calls per day. The average appointment time for these emergencies was 2-3 hours.

From March-June, business starts to amp up. For May, drive time per day averaged 4-5 hours with an average of 4 farm calls a day. On days with emergencies, drive time was 5 hours with 2-3 farm calls per day.

Our peak busy season is from the end of June to the beginning of September. When I reviewed my timeline data for July and August, my jaw dropped. I knew I spent a lot of time on the road…but was still shocked to find that the average amount of time I spent in the truck was 8 hours per day with 4-6 farm calls per day.

And the longest we ever spent driving in one day? 10 hours!! This was for a day with 4 farm calls appointments and 3 emergencies. And the longest drive I’ve made in one direction was 2.5 hours, from the northern part of the Realm to the western part of our Realm with closure of a major highway due to an accident.


Making the Most of It

When not in conversation or on the phone with clients, the first thing I do during the drive between barns is complete my medical records and invoices. This is, by far, the biggest advantage to having my assistant drive. At my previous job, when I did not have an assistant, I would have to do invoicing and notes at the end of the day…often times adding another 2-4 hours to my work day. Not only was this exhausting, but increased my errors on invoices and reduced the quality of my medical records.

Once medical records and invoices are done, other work-related tasks I do are review lab results, go over my follow-up list, and review the appointments for the next day. When that is all said and done, I move on to entertainment. I have a wide variety of music tastes, but spend enough time in the car and all types of music wear on you after awhile.

So, I discovered podcasts…a wide variety of podcasts that range from veterinary education, to psychology, crime, current events, controversial topics, history and so on. Some of my favorites include:

Favorite Podcasts from Pocketcast

Logistics behind Ambulatory Work

Occasionally, we have ride-alongs or people doing job shadows, usually students ranging from high school to vet school. For those considering a career in veterinary medicine or future ambulatory vets, it is an interactive, uncensored day-in-the-life experience. The types of questions I did not really expect to get were regarding commuting and driving. The questions I get asked most often include:

  • How big of an area do you serve? What are the logistics behind scheduling appointments? Who determines the route? How do you know how much to charge for a farm call?
  • How much time do you spend in the car on average per day? What is the longest you’ve ever driven to one place? What do you do in the car all day?
  • Does getting car sick mean you can’t be an ambulatory vet?
  • Does the truck ever break down? Have you ever gotten in an accident with the work truck?

I’ve received these questions often enough that I decided to write a couple posts about this side of the profession from my personal experience.


The Realm

Our service area (which I refer to as the realm) is vast, one of the largest I’ve seen. From where our office is located, we service up to an hour and a half in every direction…meaning our call radius is 1.5 hours, not factoring in traffic. The realm ends up being a large part of the western side of our state. While the majority of our work is North, an emergency an hour South of our office could mean a 2.5 hour drive from one end of our range to the other. Most practices I’ve spent time with service a 40 minute radius around their hub.

As for navigating the realm? I have to give a shout out to navigation apps. All of this would be a lot more difficult without today’s smart phones, GPS etc. I consider myself very fortunate to practice in a time when this technology is easily available. Not afraid to admit that I cannot imagine the farm call experience before Google maps existed. For the vast majority of our navigation, we use Google maps and Waze, which do a great job 95% of the time.


Scheduling

Luckily, our front office staff are all locals with an excellent knowledge of the cities/towns and road system. Equally important is knowledge about traffic. The commute to a particular barn in the morning could be well over an hour, while the same route could take 30 minutes if its around lunch time.

Efficiency requires concise, well-planned routes, the front desk carries the heavy burden of scheduling. And they are phenomenal at avoiding the big scheduling mistakes, which off the time of my head are:

  • Return trips (same barn more than once in a day)
  • Same stops (different doctors to the same barn in a day)
  • To-and-fro (alternating near and far locations like North  South  North  South …vs. starting north and working south throughout the day)
  • Localizing (keeping all farms in a particular direction, vs having calls at complete opposite ends of the service radius)

I have full respect and appreciation for the skills of the front desk staff, because I dabbled in scheduling at my previous job and found it to be a pain-staking, hair-pulling mess.


The Financial Side

Minimizing drive time is essential, as our farm call fees (ranging from $80-140) over times barely cover the overhead and wages one way…not to mention if the next call is equally far at the other end of our range. Often times, the company actually loses money as the basic, rough example below shows:

Farm call 40 miles from office, 1 hour drive time

  • Farm call fee charged to client: $100
  • Gas: $10
  • Vehicle wear and tear, mileage, licensing, insurance: $25
  • Assistant’s time (company cost): $25
  • Doctor’s time (company cost): $60
  • Total cost to company for farm call (one direction): $120

Not a precise or perfect example, but easy to see why scheduling and routes are so important. And after all the effort is made into tactfully planning an efficient day, there comes an emergency call that changes it all…and even if the call is at the other side of the realm, traveling in peak traffic hours, those facts don’t register because the focus shifts to getting there safely and as soon as possible, so that we can do what we joined this profession to do- care for our equine patients and the clients attached to them.

Unsolved Mystery (Part 2)

Picking up where I left off, the last entry was about an emergency case involving a non-weight bearing lameness and unexpected penetrating wound to the abdomen. Without the financial option for referral, the owner (fictitiously referred to as Karen from here on out) opted for managing the mare (fictious name of Sugar) at home. Our aggressive antibiotic required placement of an intravenous catheter, and intense training session regarding care, maintenance, problem solving and how to use a catheter. I am always nervous when it comes to client managing catheters in the field. Luckily, Karen had previous experience working under a vet in an equine surgical center.

Sugar was started on a 5 day course of intravenous antibiotics (Kpen and gentamicin) and an anti-inflammatory (flunixin). The dime-size penetrating wound was sutured closed. I expeted that the would see evidence of complications (peritonitis, compromised bowel etc) within the first 24 hours, and was pleasantly surprised when Karen informed me Sugar was holding steady. Her appetite and energy level remained consistent, as did her severe lameness on the hind leg. It wasn’t until day 3 that she threw the first fever, a staggering 104.5 F. When the fever was unresponsive to banamine, Karen took to giving alcohol baths. I was anticipating at any moment, the downward spiral would begin…but aside from transient fevers, Sugar was still holding steady at day 5.

On day 5, Karen reported the catheter wouldn’t flush and after confirming it was no longer patent, we pulled it. To continue the antibiotic coverage, Karen was given excede and her fevers had stopped. Haunting still, was the none-weight-bearing lameness that remained unchanged, and was now making me suspect a pelvic or hip injury. With her budget depleted, no additional diagnostcs or treatments were an option…and we began discussing quality of life concerns for the severe lameness. Karen painfully drew a cut-off point for Sugar’s recovery, which was a week. If her hind leg wasn’t showing improvement by the end of the week, she would have to be let go.

I didn’t hear from Karen for a week, and when an appointment popped up on my scheduled, I assumed the worst. Much to my surprise, her lameness had improved by 50%. And after another week, she was 90% sound on the left hind. Sugar never looked back after that…she recovered completely, despite the odds.

Word on the Street

And the mystery of the penetrating injury? It’s all heresay, but on my final visit to see Sugar…a neighbor just happened to swing by.

“It’s been bothering me ever since day 1. I was working in the garden, a quarter mile down the street. And you seen those big concrete pillars? Well, that day I was pulling weeds, and saw this man park his car right next to the pillars. He got out with a big black duffel bag and I remember wondering now what is he doing. At first I thought he was just working on something for the county. But he was in normal clothes, a white t-shirt and jeans. I just kept doing my gardening and it must’ve been an hour. When I looked over, he was laying on his stomach on the top of the pillar, like they always show snipers doing. And I heard my phone ring, so I went to answer it and in the middle of my phone call, there was a gunshot. My husband and I hunt, I know a gun shot when I heard one. I thought he’s poaching! I looked out to see he was still there on his stomach. So I called the police because you can’t be firing into someone’s pasture or at farm land like that. Well, I was terrified and stayed inside…I didn’t want him to know I was in there. When I heard the police knocking and answered the door, I could see over their shoulders that other cops were walking around the pillar but the guy’s car was gone. I think that guy shot the horse!”

Seeing the Signs

This story stuck with me, because a month later, at a farm in the area there had been a couple cows believed to have been shot (they didn’t die, but had wounds similar to Sugar’s. When a dog and goat were shot a months later in the neighboring town, what originally sounded like a far fetched theory…started resonate.

It’s been a couple months now, and I have yet to hear of more animal shootings…but if this really is a person targeting animals, could the target become a human? Unfortunately, the city and state police don’t consider the events related…but it also sounds like there has been little follow-up into what could be considered early indications that we have a fledging psychopath.

Luckiest vet in the world


The hostile work environment, professional sabotage and unethical veterinary practices I faced at my first job as an equine practitioner in private practice made the first 6 months a living hell. After working over 100 hours per week, my boss’s vengeful decision to “punish” me by withholding my paycheck, brought me to the breaking point. Against the advice from my family, and with the support of my friends and colleagues, I quit my first job without a 2 week notice. If having profane names yelled at me wasn’t enough, my boss then told me “I know all the vets in this area. You’re never going to be an equine vet in this state.”  My assertive response was “Not you, or anyone, will ever stop me from being an equine vet.”


2 months later

By October, I was hired as an associate at a multi-doctor equine private practice that not only has a phenomenal reputation and rapport with the equine community, but also has a “work family” atmosphere. Although I knew my previous job was horrendous, I didn’t realize how terrible it was until I started at my new job. Better hours, better pay, respect, benefits (health, retirement), mentors, the opportunity to be my own doctor, strong support staff, emphasis on the highest standard of care, safe/reliable work truck…for the first couple months I felt like it was too good to be true. I was waiting for the facade to come down, but now 6 months into my new job, and this is sincerely, genuinely the wonderful place I work.

 

The only negative/downside? My goal was to spend 3-4 years at my first job before moving to Colorado for a “dream/forever” job…and there is a little part of me that thinks darn, I found my dream job already and it happens to be in the wrong state.

 

And if that’s my only complaint…I may be the luckiest vet in the world.

Facing the Repercussions

To really understand this post in context, you’ll need to understand the backstory. If you haven’t already read the predecessor to this entry, I highly recommend it.

In order to make an employee’s last two weeks a “living hell,” Dr. Cray gave the office staff and myself her decree to engage in work-place warfare. My last post left off at a pivotal moment. I accepted the reality of the work-place situation and the brutal truth about my boss’s nature. Then, I did the thing I should have done months ago. I spoke up. I refuse to make someone’s life a living hell. And from that point on, the work-place is becoming my living a hell.


My Redefined Role and Responsibilities

Everything but a Veterinarian

Unable to hire new employees, the office was severely understaffed. Now, instead of seeing appointments in the afternoons, I was assigned to the front desk as a receptionist. This is when I began to struggle, both personally and professionally. And the troubles didn’t stay at work. With only two other employees, Dr. Cray’s started singling me out. She became uncharacteristically kind to the other two office personell, bringing them gifts each morning and asking about their weekend. When she turned to face me, she snap at me to go clean her instrument tray from the ER last night or go count the vaccines in her truck. Everything became a test or barrage of rapid-firing questions (to which some of the questions were about patients I never saw, prescriptions I was never involved in, or billing accounts that were from 5 years ago). She seemed content if I did not know an answer, and became vicious when I did. She took to devaluing me in front of clients and other employees.

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Within a couple weeks, she allowed me to see appointments only 1 day a week. When clients requested appointments with me, she told the office to tell them I wasn’t available…little by little, I watched the only benefit to my job dissipate. Veterinary experience, the only thing worth staying for, was slowly replaced by my new duties which included:

  • Restocking supplies, tracking orders,
  • Create and maintain inventory system
  • Truck inventory, maintenance
  • Manage all social media accounts
  • IT for all office equipment (phones, computer, scanners, fax, internet)
  • Invoicing
  • Equipment maintenance
  • Barn tasks (feeding, stall cleaning, turn-out)
  • Yard upkeep

Veterinarian turned Receptionist turned Detective

All those hours I put in at the front desk paid off. In an attempt to fully analyze the situation, and come up with a plan…I started gathering intel. When the UPS guy saw me up front, he said he wouldn’t bother learning anyone’s name because no one sticks around long enough for it to be worthwhile. Thanks to the UPS guy, I started looking for more information about the previous associates. I remembered she didn’t order me business cards for the first 2 months in case I was going to quit. She said she’d spent too much money on wasted cards. After looking into the business card order history, what I found was startling.

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Over the past 10 years, 9 associates were hired, and of the nine associates not a single one worked for Dr. Cray longer than a month. No surprise there! I also had mixed emotions about what this said about me. Obviously someone with a healthy amount of self respect would not put up with or stay in this type of environment. I don’t like to quit, and I will endure, endure, endure. Although I gave myself credit for getting through the last four months, I also had to change my way of thinking. I’m not here to endure. My goal and aspirations are not to endure life, endure each day. What is the sense in being in the profession I love, if every day I dread and resent going to work? I suffer, my relationships suffer, and it doesn’t do the profession any good.


If someone doesn’t know whats wrong, how can they fix it? I’m a believer in that concept, and I had been silent for too long. If we were going to make this work, we were going to have to make some changes. It was time to sit down and have a chat with Dr. Cray. I worked the meeting into our schedules, and gave her a heads up that there were some items I wanted to discuss with her.

And in 2 days, that’s exactly what we’ll do.

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