Mindhunters and Midnight Calls

For my first on-call weekend, I was co-pilot to one of the associates and assistants. Around 11:30pm, as we were wrapping up our 4th emergency of the day, we got an ER call for a horse in respiratory distress. The first address we arrived at was in the middle of a suburban neighborhood, obviously the wrong address. We idled in the couldesac while the associate, Dr. Kepper, struggled to get the correct address. It seemed no one on the phone knew the address for the residence, althought they confirmed the horse was in fact at their residence.

After 25 minutes of wrong turns, u-turns, and sleuthing via google maps, we made it to the right road. We drove quickly down the paved road, passing occasional looming, dimly lit mansions. When the driveway ended, we parked in front of a run-down expansive ranch home. None of us got out at first. We just watched the events unfold infront of us. Our arrival sparked some confusion amongst the obviously enebriated residents. Enebriation, not uncommon for late night calls, usually owners who opened a bottle or two of wine before discovering their horse had a laceration or bit of colic. But it didn’t take long observing this group of random strangers, that enbriation was a little too soft a word. Their movements were, for lack of a better word, tweaky. Their speech was incoherient, thoughts scrambled. I wondered how they had managed to call us, let alone find our practice online.

I am going to preface the remainder of the story with this small tidbit: Earlier today, I had binge-watched the second half of Netflix’s season one of Mindhunters.

One man, in his mid 40s, approached us. To access the back pasture, they had to move a truck which blocked the driveway around the back of the house. We did not think much, until a scrawny young man and man in his mid 70s came wandering through the overgrown hedges of the front lawn. From somewhere in these hedges, they produced jumper cables.

Dr. Kepper wasn’t about to wait for these shenanigans. “We’ll just walk. How far is the horse?”

The central area of the house was mostly windows with a large atrium garden. With every light on inside you could see the entire layout of the home. Dark is dark, I’ll admit. But it wasn’t until I got outside that I realized just how dark the night was. No moon, no stars, just darkness above and around. I grabbed the headlamp and Dr. Kepper carried her laptop as a makeshift light source. The guy lead us around the side of the house, wading into darkness and unknown terrain. In the light of my headlamp, I saw he had his shoes on the wrong feet, the last half of the shoelace strands worn off. He wore one dirty sock. I glanced inside the house in time to see a figure of a woman sitting on the floor rocking back and forth anxiously.

Uneven steps led down the side of the house past windows of the daylight basement. One of the windows in the basement had black, metal bars on the inside of the glass. The room was empty, but I could see a jail-style door on the opposite wall. On the other side of the rod-iron door was a normal door. No one else seemed to notice the homemade “cage.”

This was the point at which Mindhunters triggered my rampant imagination. We continued in silence down behind the house, through the middle of a pasture of unknown proportion. The only noise was the sound of us slushing through damp, tall grass. After several minutes, an old barn loomed ahead in the glow of my headlamp. Dr. Kepper marched on, following a couple yards behind the man. The barn had two big doors, but the first thing I noticed were the many, many locks and bolts and chains on the outside. It as not necessary to count the number of bolts, padlocks and chains to know that it was excessive and albeit, alarming.

The man was heading straight for the barn, Dr. Kepper striding behind. The assistant shot me a “this is #$%@ing sketch look.” I mouthed back “I will not go in there.”

Just as we thought he was going to start unlatching, unlocking the doors, he turned and lead us beyond beyond broken fencing into another expansive field. If possible, this field felt even darker than the first. I couldn’t see the house behind us anymore and I kept looking over my shoulder to see if anyone was following us.

This was when I began to wonder if there even was a sick horse here.

I kept checking behind us as I followed Dr. Kepper’s laptop glow. Just as I was going to ask how much further to the horse, a shadowy figure came into view. I feel kind of ashamed to admit it, but it was a wave of relief that washed over me the moment I saw the down horse. Then that relief vanished, and we all launched into emergency care mode.

The mare, down and unresponsive, had labored breathing, no CRT, a heart rate of 80 and weak peripheral pulse. She was matted, sticky with sweat that had cooled, and her muscles were rigid. It was very apparent she had been suffering for some time. Her body was covered in wounds, the ground around her torn up from her thrashing around. After discussing prognosis and options, the owner elected for euthanasia. Although a sad ending, the ability to bring an end to her drawn out suffering was the most compassionate thing we could do. While the owner disappeared into the darkness, we sat with the mare for a few moments before confirming she had passed.

Silently, under the glow of the dying headlamp and Dr. Keppler’s laptop, we navigated our way back to the truck. After loading up, no one said a word until we had some distance.

“I know no one attacked us or threatened us, but I just have the feeling that we narrowly escaped with our lives.” I said, and a some laughter lightened the heavy mood in the truck…right before Dr. Kepper’ phone rang with the next late night emergency.


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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.

the Vet’s Assistant

The idea of having a vet assistant in the field was obscene to my first employer. She viewed them as an unnecessary (and even impossible) expense and liability for any solo practitioner. Whether it’s for the similar reasons, most vets in the area do not have assistants. I remember reading an AAEP article back in vet school, which discussed a multitude of reasons and scenarios in which it does pay off for a solo practitioner to hire a field assistant. I remember reading the article, never having seen an equine vet with an assistant, and thinking what a luxury it would be.

Then I hit that job lottery, the place I work now. It’s not that assistants are merely an option, but that taking assistants in encouraged…and there is the obvious list of reasons. There is also the not-so-obvious list of benefits and rewards that come with having a comrade out in the field.


Teamwork Makes the Dream Work

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DVM 360 has a recent article about this very topic, called Equine vet techs deserve a seat.

Our assistants are wonderful, and with individualized training, their potential is endless. The basic responsibilities in our practice include managing daily truck inventory and restocking, manage truck maintenance/repairs/cleaning, cleaning/maintenance/trouble shooting of all equipment (xrays, ultrasound, endoscope, dental equipment etc), cleaning/organizing/packing up for all appointments, horse handling (some vaccinate and draw blood), processing in-house lab work, uploading all digital imaging/lab results, help manage schedule, driving (allowing plenty o time to SOAP and invoice for the doctor) and so forth. With the help of the assistant, I can do 3 dentals in the time it took me to do one alone. I easily see three times the number of appointments in a day with how our team works.


Unsung Heroes in the Field

But aside from the logistics, there’s the other advantages…company. It’s a lot of hours in a truck most days (2-3 hours of driving usually, sometimes up to 6 for a day with ERs and appointments). You can’t put a dollar amount on good company, especially on long exhausting or stressful days, where you have someone who was with you for every moment of it. It’s both a professional and a personal bond. Comic relief, podcast discussions, small talk, singing along with the radio, reviewing cases we saw that day, an ear to listen, or even just the feeling that you’re not alone taking on the world of equine medicine. Not to mention the safety…unfortunately, not all owners are as skilled at handling their horses as we would hope. There has been many a time (and more often than not) that the situation becomes significantly safer by having the assistant handle the horse with special restrain techniques, or even just positioning for exams/flexions/nerve blocks. I remember coming back from an ER at 3AM, after a full day of work, and rolling down the windows singing at the top of my lungs trying to stay awake on a windy back-country road….I came close to falling asleep at the wheel multiple times, and am very thankful I haven’t had to do that again.

And for everything they do, the things doctors expect, appreciate and need….there is an endless list of all the unseen, unmentioned ways that they support us on a daily basis. Being a veterinarian, you face challenging, humbling, heartbreaking and gut wrenching experiences…and experience equally rewarding, uplifting and inspiring moments. It’s those rewarding experiences that give me the feeling of happiness…and the only thing that makes that happiness even greater, is when it’s shared with a teammate.


Thank you to all the veterinary assistants and technicians who remain unsung heroes in the veterinary field. Whether you’re in the exam room, surgery suite or field, the wonderful aspects of vetmed would not be nearly as wonderful (or even possible) without you!

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.

the Unexpected Problem #2 (ER case, part 1)

After seeing a couple of routine appointments, we started receiving back-to-back emergencies. Our emergency calls included a colic, a foot abscess, a case of cellulitis and a minor laceration. Around 9pm, right as we parked the work truck in the garage, my work phone rang. On the other end of the line, was a panick stricken owner who thought her horse had fractured its leg after getting kicked by another horse in turn-out. We regrouped, and made the short 25 minute drive to the ER.


The Presenting Complaint and (Most) Obvious Problem

When we arrived, we spotted the mare in the beam of our headlamps. She stood in the pasture, trembling, painful and unable to bear weight on her hind leg. Aside from a <1 inch long laceration through the skin located in front of her hip, there were no real significant findings on my physical exam. I could not palpate a fragment, fracture or instability in the limb. After ruling out a foot abscess, fracture of the distal phalanx, we confirmed no fracture from the stifle down. Our radiograph equipment in the field is not capable of shooting images of the hips or pelvis, and with no ultrasound, ruling out a pelvic fracture wasn’t going to be an option. Leaving her in the pasture, without water or shelter, was not an acceptable option. After giving pain meds and sedation, we inched our way slowly and steadily to the barn.

Discovering the (Less) Obvious, but Equally Serious Problem

In the barn, I turned my attention to the wound over the hip while I next steps for the painful leg. After clipping around the wound, I was both shocked and disturbed to find out the extent of the wound. What looked like a superficial, small tear in the skin, was actually a dime-sized penetrating wound. With a flashlight, I looked into the wound and probed the extent. Beyond layers of muscle, fascia, fat and connective tissue…I found myself looking through a tiny viewing window right into the mare’s abdomen. I saw the glisten of light off what I presumed to be the right dorsal colon.

Bad Gets Worse

A penetrating wound into the abdomen doesn’t carry a favorable prognosis, especially when managed in the field. The client’s financial constraints meant referral for hospitalization was not an option. Abdominocentesis (belly tap), bloodwork, ultrasound, SAA…also not within the financial realm. Dedicated to trying, and wanting to give the mare a chance, the client asked for the most aggressive approach we could take to treating in the field within set limitations.

Antibiotics, anti-inflammatories, suturing the wound and monitoring comprised the mainstay of our treatment protocol. To be honest, I was expecting these efforts to serve mainly as a comfort and reassurance that we had tried something. I’ve seen horses succumb to far less serious ailments with intensive treatments and hospitalization. We placed an IV catheter so we could start a robust course of antibiotics (kpen and gentamicin) and banamine.

Where it gets interesting

By 1am, we had discussed catheter care, administer meds, given extensive instructions on what to watch for…and when we left, the entire ride back was filled discussions on everyone’s thoughts, ideas, speculations …wondering about the source of the lameness as well as the surprising penetrating hole. The hole was clean through the side of the horse, with defined edges and minimal surrounding trauma…almost like it had been made intentionally, by someone blessed with the art of careful dissection. Without knowing the systemic status of the horse, I could hardly sleep with thoughts of the undiagnosed fracture, the possibility of punctured bowel, the chance that whatever punctured her side could be floating around in the abdomen, the imminent danger of sepsis and endotoxemia…this, combined with group speculation as to what caused the wound.

A stick?

A nail?

Fencing?

Tree branch?

What about a bullet? The client asked, explaining that the family dog had sustained a similar injury a year ago when he had been shot with a small-caliber gun (pellet gun or 22?) by a disgruntled neighbor. With so many unknowns, possible complications and serious risks associated with this emergency case… I was not optimistic about the outcome of our next visit, which I expected would in the very, very near future.

That moment when you’re really glad you did…

Having never performed field castrations completely on my own, I served as the anesthetist while my boss performed the routine surgeries in barn pastures and backyards. Although her castration tool-of-choice is the Henderson drill, she took to demonstrating the different surgical techniques (open vs. closed) and cycled through the different types of emasculators with each castration. After watching five or six castrations, the opportunity for me to perform my first castration presented itself in the form of a laid-back, confident client and healthy six month old Thoroughbred colt. My boss kept a watchful eye from her position at the neck of the horse, while I talked my way through each and every step of the procedure. For the entire 20 minutes that it took me to perform the castration, my heart felt like it would pound right out of the chest. My hands trembled the entire time, and it wasn’t until I was done that the client said I did a thorough job. She said she knew I did a thorough job because apparently I narrated step-by-step the entire surgery. I was so focused, I wasn’t even aware that I’d done that. My first castration went well, and was without complication. Now, it was just a matter of getting a few more castrations under my belt before I’d be performing them solo in the field.

Unfortunately, starting out as a young doctor and being new to ambulatory practice, I ran into some difficulty getting consent from owners. On multiple occasions we hit this roadblock, when clients were not on board for allowing a “fledging doc” cut their colt…regardless of the well-seasoned and experienced veterinarian watching my every move over my shoulder. Each time the plan changed, the itch for experience got stronger and stronger. After 3 months, and having watched over 15 castreations, I was chomping at the bit.
When we showed up on the small mom-and-pop farm, the plan was for me to make another notch in my castration belt. The horse was a 5 year old Arabian stallion, recently purchased and barely halter-broke. He was so high strung and wire, that just the act of sedating him alone, was quite the feat for my boss and I. This ordeal was enough to change the minds of the clients, who recanted their original offer for me to perform the castration. I settled into my role as assistant and anesthetist, and tried to push the itch out of my mind.

Several rounds of sedation later, the colt was sedated enough to anesthetized with my boss’s ketamine protocol. He dropped quickly to his side, and we got to work positioning and scrubbing the incision site. Within a few minutes, he was starting to wake up from the anesthetic. My boss is one fast lady, and it takes her less than 5 minutes to castrate a horse. She placed the Henderson drill and spun each testicle off, she checked from hemorrhage and then gave him a rinse. About the time he was getting his antibiotic injection, the gelding was strong enough to push me off his neck and stand to his wobbly feet. My boss took his halter, and I helped balance his staggering hind end as we made our way toward the barn.
As he took several steps, a normal amount of blood slowly dripped onto the gravel..leaving a breadcrumb trail of red droplets. By the time we’d gone 150 feet, the slow drip became a fast drip…which then became a weak trickle of blood. In the stall, I called my boss’s attention to the steady stream of bright red blood coming from the incision site. I rounded up some gauze and fed it along as she packed it into the incision and simultaneously dodged his attempts to kick her. As she packed more gauze, the amount of bleeding increased. The gauze was drenched, and after packing three rolls in there, the bleeding was not improved. He was more awake at this point, and took to slamming us against the stall wall.
After several minutes, it was apparent the packing wasn’t going to be enough to stop the bleeding. A large blood of blood had accumulated, and the rate of hemorrhage was even greater. We made the decision to anesthetize him again in order to explore the incision and locate the source of the hemorrhage. The boss drew up the drugs, and we didn’t waste any time laying him down again. The amount of blood and the fact that he was only lightly anesthetized made identifying the bleeding structure difficult. Without good visualization, we worked somewhat blindly. The boss clamped some hemostats down on the part of the cord she could find and left them while she packed around the instruments with gauze. No sooner had she gotten the gauze mostly into the incision, did the gelding try to jump up onto his feet. I struggled to hold him down while the boss unclaimed the hemostats and packed the rest of the gauze. He nearly launched me over his shoulder as he made several attempts to stand. When he finally stood, the bleeding appeared to have ceased. Everyone breathed a sigh of relief, and the owners, my boss and I guided the horse to his stall for a second time.

I was in the middle of cleaning instruments when I heard a commotion from the barn. The owners went running past me towards the barn, and I could hear someone yelling help. “We’ll just euthanize him” the owners was saying as we all ran towards the barn. I had obviously missed something, and didn’t know who or what was being euthanized. “He’s going down!” The owners sounded panicked, and I arrived at the stall to see the gelding buckling his knees. “Just euthanize him on the lawn.” The husband said decidedly. My boss was helping to hold the horse against the wall of the stall. She looked mostly confused but there was a hint of some other emotion I couldn’t recognize. From between the gelding’s legs, blood was gushing down and into the shavings between his feet.

“What option do we have? We can’t put any more money into this.” The clients kept saying. My boss was now looking concerned, a look I haven’t seen too often. She usually exudes confidence, but definitely didn’t exude that when she was studying the profuse amount of blood coming from the incision site. The hemorrhage was significant enough that now I felt the real weight of the situations urgency.

“Your options? The referral hospital for surgery. Or we can euthanize him. Or we lay him down again?” The owners quickly shot down the hospital option due to finances and said to just euthanize him…and quickly before he collapsed in the stall and further complicated the situation. “Euthanize him?” There was no hiding the surprise in my voice. “We’ll just lay him down again.” I said. “I’ll draw up the drugs.”

“A third time?” The wife asked me.

“I’d lay him down 5 more times before going the euthanasia route. After I give him the drugs, he’s going to be out for awhile. He’ll be in a very deep sleep so we’ll have time to really get in there and find the bleed.” A Drew up my anesthetic protocol, a combination of ketamine and diazepam that put the gelding on the ground again, this time in a very deep slumber. After performing over 200 anesthesia at the internship, I developed a dependable anesthetic protocol and I have complete confidence in both my drugs and their dosages. My go to IV pre-mads are butorphanol and xylazine, and my induction drugs are a combination of diazepam and ketamine. A small bump of ketamine extended the anesthesia time, and kept the gelding out for the entire time that was necessary. My boss explored the incision site, welding handfuls of clotted blood and searching for the source of the hemorrhage. At one point, the gelding was so still my boss asked if he was still alive. As if right on cue, the gelding took a slow deep breath. I rinsed the area as my boss explored the cavity, feeling around blindly. When her gloved hand emerged, it was holding the end of a large bleeding vessel and shredded wisps of soft tissue. The testicular cord had been torn, which had resulted in the hemorrhage. My boss placed three transfixating ligatures, and afterwards we both studied it for bleeding. When no bleeding occured, she let the cord recede back into the incision.

“In 20 years, I’ve never had this happen.” My boss admitted. You bet we high-fived right then and there, bloody gloves and all. I was mostly just relieved. Hemorrhage is a real potential complication of castration, and it was the first real “bleeder” I had seen. While he slept off the drugs, we placed an IV catheter and started him on fluids. As the gelding recovered from his third round of anesthesia, we walked him back to his stall.

“Well, that’s one way to get to know the new vet.” One of the clients said as we packed up. “We were ready to euthanize him right here.”

“Well, not with Dr. Morgan here you weren’t.” My boss said as she gave me an appreciative look. Both clients gave us hugs, followed by a series of thank yous.

“Can tell you’ve done the whole anesthesia thing once or twice.”
I had to laugh when the client said this. All the hours spent running anesthesia during my internship, wishing I was doing anything but anesthesia. Counting down the days til I could turn in my anesthesia badge and never set foot in the anesthesia room again. And here I am, 5 months later, having one of those moments when despite all the weaknesses, hardships and trials that surrounded the internship experience, I’m really glad I did it.

#veterianrian #vet #vetmed #vetlife #equine #horse #equinevet #ambulatory #mobilevet #veterinarypractice #dayinthelife #doctor #profession #equineveterinarian

They all go differently.

Euthanasia, and the process of euthanizing, is not a new concept or experience for me. My first euthanasia experiences were assisting with the euthanasia of research animals while working for the USDA and veterinary micropath department of the vet school. Horses, sheep, goats and cattle were the species involved in various research studies. There was a set protocol in place that made the process fast and efficient, which while it sounds cold, was also very humane. Some animals appeared healthy on the outside, and these were the more difficult ones to euthanize at the conclusion of a research study. Other animals were deeply affected by disease, and it was a deep relief to see them at rest and at peace.

While respectful and maintaining dignity of each research animal, the emotional element that is embedded in the relationship between owner and pet was missing. It wasn’t until I was working at a small animal hospital before veterinary school that I was exposed to the emotional elements that follow with the decision of an owner to say goodbye to a beloved pet. These cases, I will admit, tear me up. I have always linked with people’s emotions, and have an unwavering empathy for people. When an owner is sobbing or tearfully talking to their pet for the last time, I cannot help but shed tears. I’ve faced some unkind remarks from colleagues for this visceral reaction I have, but the truth is…I’m okay with it. It’s my most candid display of truely caring, both for the animal and the person attached. There is no shame in it.

Throughout veterinary school, I never had a patient that was euthanized. But I experienced my own loss in veterinary school when my 18 year old lifelong companion, my childhood cat, was euthanized after secuming to alimentary lymphoma. It was the single most significant and profound loss I’ve had in my life so far. It was traumatic, painful and was compounded by the fact that I probably waited a little to long to come to the decision. I didn’t realize this until after he was gone, and it remains a haunting realization.

Then, my internship brought forth many euthanasia experiences. I performed my first solo euthanasias in my final six months. For the most part, the process went quickly and well. The nature of euthanizing a horse appears sudden and abrupt. One minute the are standing, then they collapse. Sometimes, it is violent. There are many factors that contribute to how a horse goes down, and how quickly they are gone. Of the euthanasias that appear more difficult, or prolonged, I have noticed that these horses tended to have underlying cardiac or neurological diseases. There is individual variation, even without underlying disease (that we are aware of). On a rare occasion, there has been human error…but this is a deceiving statement. When it comes to injecting the solution, the most important part is that the entire solution enters the vein. In horses, this is the jugular vein. The Drug acts to stop the heart. The appropriate amount must enter the bloodstream, for a partial dose can render a situation fraught with danger, stress and possibly chaos. There are plenty of stories of euthanasia gone ary. It’s a haunting experience for everyone involved…and certainly the very last thing a veterinarian would ever want an owner to witness.


My first bad euthanasia experience happened on the second to last day of my internship. It was a middle-aged gelding that presented for severe colic, and Surgery was not an option. Despite medical management attempts, he became progressively uncomfortable and the decision was made to euthanize. It was the resident and I on the case, and owners were a younger couple struggling to keep their composure as they made the difficult decision. They had also decided to not bare witness, and were about to leave after final goodbyes. As they were stepping out, they changed their minds. They wanted to be present. We had to load the horse up on Pain killers and sedatives to buy me a couple minutes to grab the euthanasia supplies. Because of the horrible weather, we chose to euthanize in the work-up stall. At this point, he was being restrained in a shoot (a mobile door that swings, and keeps horses against the wall.
I injected the euthanasia solution into the catheter I had placed an hour before. All was still, while I held the door and the resident held his head. It was 30 seconds later that he started buckling and then launched forward. He took a nose dive, and his hind end almost came over his head. He started kicking within the chute, and the resident was doing everything in her power to hold him back for fear if he broke lose, he could crash into anyone or anything. Then, he had what appeared to be a seizure…rhythmic banging within the chute. The only other thing I could hear aside from his grunting and kicking was the owners gasping and running out of the room. Then, he sighed and passed away.

We don’t know this happened this way, with an adequate dose and a patent catheter into the jugular vein. There are many theories, I’m sure. But unfortunately, we’ll never know and worse yet, is that these were the last moments the owners will remember forever. I cried as soon as I got in the truck, cried all the way home, and then cried as I told my roommates what happened. It was one of those moments that brings up a barrage of negative feelings and the sense of ultimate failure. Guilt, shame, disappointment, fear, regret, remorse, confusion and shock…all in the face of failure. And I definitely started asking myself if I should even be a vet if I cannot be a good one.

#veterianrian #vet #vetmed #vetlife #equine #horse #equinevet #ambulatory #mobilevet #veterinarypractice #dayinthelife #doctor #profession