The Work-Place Honeymoon Stage …is Over

Unlike my usual posts, this one isn’t about a particular case, patient or exclusive veterinary experience. This post falls under the venting category and serves two important purposes.

  1. Venting (everyone needs an outlet)
  2. Documentation of events (just in case)

There have been concerning changes at my work-place over the last couple months, and largely have to do with my boss/practice owner, who I’ll refer to as Dr. Cray. These changes and the current conditions at work are certainly not unique to the veterinary field. Unfortunately, I know situations like these can plague any professional field and work-place. I also know there are far worse working conditions and nightmare bosses out there than what I’ve experienced.

So, if you already know that there is nothing I can say to make it worth your time to read the following gripes, complaints, emotion portrayals and speculations, then I recommend passing on this one. Otherwise, I’m an open venue to opinions, thoughts, shared experiences…please feel free to comment or message me.


When the work-place honeymoon stage is over…

During my interview back in January, Dr. Cray made a great first impression. Out-going, charismatic, enthusiastic, charming and equipped with a great sense of humor. Afterr 20 years working as an ambulatory vet, she still appeared to be very much in love with her job. After the working interview, I remember thinking ‘Wow, I hope someday my clients like me that much.’ The admiration, appreciation and respect that clients had for her was irrefuteable. Some ever professed how much they adored her during the appointments. She was friendly and kind to me, and told me she had been waiting a avery long time to have an associate. She mentioned in passing that the last two associates she hired quit within the first month. Hindsight: Red Flag #1.

Within a month of starting work, I began seeing appointments and we split emergency on call 50/50. She was an endless source of support, encouragement, advice and constantly reassured me that she would never ‘throw me to the wolves.’ The first 6 weeks were the golden weeks, when we could do no wrong, talked endlessly about cases, life, experiences, teamed-up on on a in-patient laceration and fed off of each other’s enthusiasm. Every morning, I was excited to go to work and was oblivious that unbeknownst to me, this Honeymoon Stage would be wrapping up shortly.

During the internship, I was the “ER magnet.” Meaning, if I was on call, everyone could expect at least one emergency. This carried over to my new job once I started taking on-call. My first weekend was jam-packed with ERs, and I had back-to-back overnight ERs. The ERs came in waves, spilling into the weekdays. With at least 3 ER calls a day and a schedule entired booked with apppointments, we had to divide and conquer. At the end of the week, she said “Thank goodness you are here. I would not have been able to it without you.” That is the last kind thing I remember her saying to me.

Around week 8, I started to notice passive aggressive remarks directed at me. I gave them no mind, since you never know what people are going through outside of work. I remained pleasant, out-going and supportive. Then I became acutely aware that while I received microaggression, the rest of her employees faced direct aggression. I remember thinking that her way of dealing with stress, by treating others like pin-cushions, was both unprofessional and unkind. She would usually target one person on any given day, or sometimes for weeks at a time. They received relentless redicule, demeaning comments, interrogation and agregious amounts of blame- for anything and everything. Sometimes people were targeted after making a mistake, sometimes it appeared to be random.

I was not quick to realize that her passive aggressive comments towards me were replaced by the cold shoulder technique. This cold shoulder, silent treatment and general indifference to my presence lasted a couple weeks. This was the calm-before-the-storm stage, and the air was constantly charged with tension. In the office, you could feel and see the tension enter the room with her. As just as it arrived, she took it with her when she left. I noticed employees sigh quietly with relief after she would leave for the day. It was until she left that I realized we were all holding our breaths, and figuratively navigating the egg-shell laden office.

At this point, I still chalked everything up to “she must be going through something, and like everything, this will pass.” Probably because I was trying to create the reality I wanted by altering my perspective. To employees who had been around for awhile, all of this was nothing new. Employees either silently accepted this as the way things are, or they quit. This lead to constantly revolving door of employees. Red Flag #2.


the Revolving Door

I was told employees were rarely fired because Dr. Cray didn’t want to risk them receiving unemployment. Instead, she used her own technique that she referred to as “driving them out.” She insisted the office manager do this as well. Basically, make them so miserable at work that they quit. Make working there unbearable.

During a 10 week period, 5 people were hired, 5 people quit, and 1 person was fired. Sometimes Dr. Cray decided she did not like a new hire (specifics were never given as to why or when she disliked them), and sometimes she just wanted new hires gone for no apparent reason. We knew this was coming when she would “flip the switch” and relentlessly target someone for no apparent reason. Everytime this happened, the new person quit. During my time here, no new hire lasted longer than one month.

Katie, a part time assistant manger, worked another full time job and had a third job, in addition to being a single parent. She worked for Dr. Cray for 10 years, and said this is the way things had always been. For the last 6 months, she had been trying to quit in order to take better care of herself and her daughter (health problems, fatigue and family emergencies). She was met time and time again with one of Dr. Cray’s emotional weapon of choice, guilt and shame. She gave a 2 month heads up that she would be leaving, with the hope that this would provide ample time to hire a replacement. During Katie’s last two months, Dr. Cray refused to acknowledge Katie’s presence…unless it was to scold, demean and guilt trip. She repeatedly pressured Katie to work on projects from home without compensation (yeah, for free!), since Katie was “screwing the business over by quitting.” During her last few days of work, Dr. Cray repeatedly told her “I hope you know, you’re really screwing me over.”

Like all the other new hires, Katie’s replacement gave her 2 weeks notice within a month of being hired. Upon hearing the news, Dr. Cray’s looked as if she’d just accepted a challenge from a rival.

“Oh yeah?” And as if making a call to arms, she said “Let’s make her last two weeks a living hell.”

When I heard her say this, the gravity of the situation finally hit me. After seeing her blatantly wage work-place warfare, and ordering her employees to engage in it, I did something I had not done up until this point.

I looked at her and calmly said “Yeah, I’m not going to do that.”

And ever since the moment I spoke up, things have been getting much much worse.

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

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

A whole ‘nother species

Even though I was hired on as a predominantly equine vet, and have concentrated my efforts, time, professional endeavors and life to equine medicine, I accrued a decent amount of experience with small ruminants both before and throughout vet school. I’d like to place the emphasis on the descriptor ‘small’ ruminants. I’ll ride along with my boss on any call, no matter the species. There is one species (well, excluding camelids and pigs) that I absolutely don’t feel confident in. Cows.

On my treasured Saturday off after a rough week of colics and lacerations, I knew something was up when my boss rang. She sounded optimistic, “Whatcha doin’?” I was honest, and she knew my sleeping habits by then. On any Saturday I have off, at 9 am you can bet I’m sleeping. She informed me she had three emergencies that had simultaneously called and were all in different directions. She was nearly to one, and the next one was a horse with a laceration of unknown proportion. She didn’t have to ask because I knew why she was calling. “What ER would you like me to take?”1500039069095-542038303

Three words over the phone and I was wide awake.

Sick.

Down.

Calf.

The other calf they recently acquired had died in the night, and my boss suspected this farm call was more in the direction of euthanasia than heroics. I headed out with the address plugged into the GPS and an ETA of 30 minutes. Highways to streets to gravel road and the numbering on possible driveways became scarce. Luckily, I had discovered the Google Maps’ satellite view and this helped tremendously with locating barns and houses. But, satellite imaging via Google Maps was nothing without mobile data. This ran out with about 4 miles to go and I ended up taking a long gravel road that zigzagged past caved in barns, abandoned double-wides and the occasional deserted house. The road ended at a picnic shelter camped out in front of a lake…I hadn’t passed anything matching the physical address of the house I was looking for.

Out across the open pasture, I spotted an old, tiny run-down cabin. (I might have overlooked it as a storage shed, but after a couple months of farm calls in this area, I never underestimate what structures serve as someone’s home). I heard the lawn mower first, then spotted the red riding lawn mower as it rounded the shack. It’s rider was a shirtless man in his 60s or 70s, with tattered suspender straps over his shoulders and a wide brimmed straw hat. He sported a cigarette from one corner of his mouth, and a long piece of straw out the other. His jack Russell sounded the alarm. I waved as he slowly made his way over to the truck. Over the barking dog, I asked if he happened to have a sick calf. He left the lawn mower idling as I got out of the truck. He gave me a once over look and shook his head. He looked disinterested and slightly annoyed and motioned over his shoulders “My neighbors have a calf.” Then he gave directions that sounded as helpful as google map’s “no network” message.

I started to get into he truck when he hollered. “Are you the animal doc?” And I answered yes.

After I answered yes, he gave a mischievous grin and winked. “If you’re the doc, I’m an animal. You want to work on me?”

I shook my head and put some effort into a laugh, one of those ha-ha very funny laughs. Then I got in the truck and performed a 7 or 8 point turn as the self-proclaimed animal on the riding lawnmower made cat calls.

The truck’s diesel engine is loud, but wasn’t loud enough to drown out the series of howls he let out from under his wide-brim hat.

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

VET LIFE STEP BY STEP – HOW TO LOSE A CLIENT

I unintentionally discovered one method for ensuring you will not have repeat business from a client. And for the sake of showing my humility, while sharing my mishaps, I created a simple step-by-step guide on how to lose a client.


HOW TO LOSE A CLIENT IN 5 SIMPLE STEPS

1. Ask client if they would be willing to move their appointment up to an earlier time, preferably if it will involve them rushing or canceling previously made plans. Schedule them for this earlier appointment time.

2. Show up 1 hour late.

3. Promise you can accomplish all the appointment goals by a particular time.

4. While they are helping hold your patient in preparation for a dental float, spray them directly in the face using a dosing syringe full of dirty water from the horse’s water bucket.

5. Finish the appointment 30 minutes later than you promised so that it interferes with the plans they had to rearrange in order to meet you at the time you requested.

 


When my boss couldn’t make it to her appointment at a nearby barn, I offered to step in and help carry some of the appointment load. Not only was this my first time meeting the client, but it was also the same barn that I had visited earlier in the morning for an emergency colic appointment. This client had one horse scheduled for a dental and two horses scheduled for vaccines. Having been on emergency calls all night, and reporting to the Colic first thing in the morning, I never had time to get vaccines. When I agreed to take the appointment (Since I was already at the barn), I also realized I was out of tetanus, West Nile and flu/rhino vaccines. While my office staff arranged for the client to come to the barn at 11 am instead of 2pm, I embarked on what I thought was going to be a quick trip to the office for more vaccines. But phone calls, questions, client drop-in and various other events resulted in my taking an hour longer than I had hoped.

By the time I showed up at 12pm, the client had already called my boss to see what the deal was. She let me know what her wait time had been, and I apologized profusely. With a riding lesson scheduled at 1, she was skeptical I could get everything done in an hour. Determined to regain her trust and confidence, I promised I’d have it done.

I set up my dental equipment, vaccinated the horses and got ready to sedate the gelding for his dental. “Oh yeah, he doesn’t sedate well just so you know. He’ll look like he’s about to fall over asleep, but as soon as you start working on him he’s wide awake.” Let’s just say she knew exactly what she was talking about. And after I felt confident in his sedation level, I filled a large dosing syringe full of water from his dirty bucket. I put the tip of the syringe in his mouth, and as I shoved with all my might on the plunger…he almost reared up. It was perfectly coordinated and timed, and instead of the water going into his mouth…the water shot full-force straight into the client’s face.

Basically, she got a power-wash to the face and was soaked. She did not laugh. She looked absolutely pissed and annoyed. I told her I was mortified, and that I was sorry. To which she responded, “I’ve had much dirtier and nastier things on my face.” I laughed, and went to work.

What would’ve normally been a 15 minute dental float was a 45 minute struggle between a horse’s buckling knees and his frantic swinging head. By the time I was done, the client had her own client waiting to begin the riding lesson. Embarassed, mortified and disappointed by the multi-modal failure, I left one more apology with her before I drove off to the next appointment.

As soon as a left the barn driveway, I was dialing the office to give them the step-by-step account, and share my new found method to ensure that I’ll never be the vet she requests to work on her animals. We all had a good laugh before the office manager said, “Well, I doubt it cost us any money. She’s had an outstanding balance of over 3 grand for the past couple years and refuses to put a dime toward it.” She paused. “Maybe after spaying her point blank in the face, she’ll get the hint that we kinda want to be paid for our previous services.”

Despite her account delinquency and bad attitude in general, I still felt horribly unprofessional and foolish…though after talking with the Office manager, I felt a little less guilty.
#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