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Friday, 9 July 2010

Students.

Come in all shapes and sizes. 

There are big ones, little ones, fat ones, thin ones, irritating ones, arrogant ones, ones that sit on your chair, ones that criticise you, ones that know more than you and quite a lot that know very little, ones that make tea and bring biscuits and ones that don't.

By and large they are all pretty good.....at wiping the table.

Yesterday we had an appointment booked in for a chicken with diarrhoea. 

Because I know nothing about chickens I set the student the task of researching causes and treatments of diarrhoea in chickens. Away she went and buried her head in the books for well over an hour.

When the patient, 'Lady Gaga' finally arrived in a large cardboard box we were prepared.

'We have been eagerly awaiting your arrival and the student has been preparing for you all afternoon.' I told Mrs chicken owner. 'She's going to ask some questions.'

'Right.' Said the student removing a folded piece of paper from her pocket (while the patient remained cellotaped in the box). 'Is the diarrhoea brown, yellow or green?' She asked eagerly.

'It's sort of foamy yellow.' Replied the client.

'I have the diagnosis.' Said the student.' Salmonella!' She exclaimed happily.

'I think we should perhaps start with an examination before we get to a diagnosis.' I told her as I judged a look of horror in the clients face.

As a new graduate I remember the day I was presented with a snake. I spent twenty minutes taking a detailed history on husbandry whilst the owner continuously tried to interrupt. Only to find that what she had been trying to tell me was that the snake had died en route in the car.

Whilst there is much that can be learnt from a book there is so much that can only be learnt on the job and one thing you learn very early on is that a diagnosis is never as simple as a colour coded chart....

Wednesday, 23 June 2010

World Cup Fever.

'Oh hello there I am phoning from the vets. My client has just had her cat put to sleep, she's very upset and would like to bring her straight up to your pet crematorium. Will that be ok?' I ask.

'Well tell her she'll have to be quick.' The man from the crematorium replies sounding a bit peeved. 'We are switching the furnaces off at 2pm today and kick off is at three so we'll be shut before then.'

'Thank you for being so sensitive to her needs, I'll tell her to come straight away.' I say sweetly.

It would appear that even the furnaces stop for England when they are playing in the world cup.

But us vets are not immune to the addiction. I installed a small TV in the vets office and appointments were made mainly through half time.

Twenty minutes into the game my colleague stormed into the office.

'Can you believe a lady has just brought her guinea pig and her eight year old boy to the surgery?!' She ranted. 'Does she not realise the poor child will be bullied mercilessly for missing the football?'

Yep, world cup fever has infected us all....

Wednesday, 16 June 2010

One Trick Pony.

'Then the 4 mm screw goes in the 3.5 mm hole and you have to make sure you tap it first, you might need a 10.1 mm hole or maybe a decompression, compression, dynamic compression plate, make sure you prebend it.' Says the lecturer wearing glasses and trousers that are too short for him.

I thought orthopaedics would be my thing, after all I am marvellous at DIY and own a healthy tool kit.

But heres the worst part, I can actually feel those words bouncing off my forehead and leaving dents in it because they just won't go in. I have booked myself on an orthopaedics course to prove I am not a one trick pony and the only words that are bouncing around on the inside of my head are 'Boring, boring, boring.'

At the end of the second day I am clock watching. I hate the brutality of it all, even though I am not performing the procedure on a live animal it all feels a bit gory and un-natural. 

'I can't drill a hole in the bone.' I tell the ankle swinging lecturer as I grow exasperated whilst performing a 'tibial crest transposition.'

'That's because you have the drill in reverse.'  He tells me.

That was the moment when I actually finally learnt something. I learnt that I am never going to be good at orthopaedics.  

Why do I love internal medicine so much? 

I don't come from a medical background but my mother passed on a love for crime fiction which encouraged an enjoyment of problem solving and conspiracy, CSI fans will understand. My father taught me how to become better at source analysis for my history exam. 'When you look at an old picture, don't just try to see what it tells you, but look for what it doesn't tell you.'  So the seeds were sewn a long time ago.

I love medicine because it is varied and intricate, because it follows the rules but also breaks the rules. It is unpredictable and challenging and there's no better feeling than solving a difficult puzzle- it is like an episode of 'House' but without the walking stick.

An orthopaedic surgeon would argue that a challenging fracture represents a difficult puzzle- but I think its safer  all round if LittleVet just sticks to putting up shelves….

Monday, 14 June 2010

History taking.

'What can I do for Maisey today?' I ask Mrs Brown, the owner of an obese middle aged Retriever that waddles into my consulting room wagging her tail.

'She's a bit off.' She replies as she takes off her grey rain coat and slumps into my chair, clearly she intends to be here some time. Maisey settles down at her feet.

'How do you mean?'

'Just sort of off, you know, just off.'

'Is she depressed or quiet?' I ask.

'No.' She says shrugging her shoulders.

'Has she had any vomiting or diarrhoea?' I try to ascertain the specifics.

'No.'

"Any coughing or sneezing?'

'No.'

'Any change in appetite or drinking?'

'No.'

'Weight loss?' Although I feel it unlikely given Maisey's girth.

'No.'

'Any symptoms at all?'

'No. Just, you know, a bit off.'

Pause. 

'But she has been sick quite a lot now I come to think of it.'

Finally something I can work with...

'How long has been sick for?' I ask enthusiastic about my new lead.

She removes her hat and gloves. Looks down at Maisey who is now asleep.

'Oh, just a while.' She replies.

I wish the people who taught me that history taking is the most important part of the examination could be here now....


Sunday, 9 May 2010

While he's under.....

Imagine the scene.

Benji the Labrador is collapsed on the consulting room floor, his gums are white, his blood pressure is not registering on the fancy machine and he needs surgery to remove a ruptured spleen or he will die because his abdomen is filling up with blood and he is bleeding out.

Mrs Smith, Benji's owner has had the procedure explained. She has signed the consent form. The atmosphere is tense. There is no time to waste. Just as she is about to leave Mrs Smith turns to me and says in a bright and breasy voice 'Oh, and while he is under do you think you could clip his toe nails?'

Just one example of some of the many irritating and trivial requests I have had prior to performing life saving surgery. Others include:

'Could you give his teeth a quick clean?' 
'Perhaps you could empty his anal glands?'
'Do you think you could clip the matts out from behind his ears? He hates it when I try to brush them out.'
And 'I don't suppose you could spay her while you are in there?'

I just nod with a thin smile.

'Mrs Smith, I am just phoning to tell you that Benji survived the surgery.' I say happily to hours later.

'Did you manage to get his nails done dear?' She asks.

'Yes.' I reply curtly.

'Oh that is a relief.' She says.

Friday, 23 April 2010

Barbara Woodhouse

Mrs Brown brings her Labrador Sophie in for a vaccination. Mrs Brown is slightly cross eyed, her dog Sophie is very badly behaved. Before leaving she asks if there are any other dogs in the waiting room because Sophie is not very sociable. I open the door and Sophie leaps through the gap. In seconds she has transformed herself into what sounds like a snarling pitbull, tugging and pulling Mrs Brown and her boggling eyes towards a small terrier.

I grab the lead from Mrs Brown. I yell at the top of my voice 'Will you sit DOWN and BEHAVE!!!'

Sophie's arse hits the ground, she looks overwhelmed and surprised that someone has taken control. Two male drug reps in suits also sit down immediately. There is silence as I walk Sophie to heal to Mrs Browns car passed several other dogs.

'My God you had that dog under control.' Mutters one of the reps when I return to my consulting room.

'Barbara Woodhouse lives on.' I reply. 

Tuesday, 13 April 2010

The simple truth

The basket is carried precariously by a nine year old girl and her five year old sister, it swings from side to side and occasionally bashes the wall but there is no movement from the emaciated body lying at the bottom. This will be Megan the cats last visit.

'The girls and I have had a chat and they would like to stay while Megan is put to sleep.' Says mum who is very upset.  

As I leave the room to get the nurse I hear the five year old asking 'Mummy what day are we picking up the Bulldog puppy?'

Megan has no veins because Megan is nearly dead. I have to give the injection into 'the tummy' which sounds better than telling the truth, namely that the injection has to go into the kidney.

The five year old girl has to reposition because she cant see what is going and wants to see properly as I push the plunger.

Now I need to ask Mummy whether she wants to bury Megan without the girls catching on, because I have found over the years that most parents do not want to take the body home but most children want to have a full on funeral and official burial.

The nine year old over hears me mouthing the words 'Bury?' or 'cremation?'

'Mummy we have to bury her!' She says defiantly.

'Darling because we don't live with Daddy any more we don't have a garden.'

'We want to bury her!' Cries the five year old.

'How about you take some of Megan's hair and bury that?'  I offer.

Both girls are frowning. 

'Ok.' I sigh.' You have two options, either you can take the hair and I will take Megan and she will be cremated, then she will be scattered at the top of a lovely hill overlooking fields with lots of other animals or you can take her home and bury her in the garden where she will be eaten by worms.'

They take the hair and leave....