veterinary medicine

Living with Each Other’s Choices

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I feel like I’m sharing a well kept secret of veterinary medicine here. Except it shouldn’t be a well kept secret or a secret at all. Your pets; they belong to you. They are yours. You are the decision maker when it comes to their healthcare. Our job as veterinary professionals is to understand your problem, use our training and understanding to formulate an approach to the problem and finally, share all of that with you in the form of a recommendation.

That’s all it is. A recommendation. You are always in the driver’s seat. Sometimes, it seems like you don’t have a choice. Sometimes there are few options and sometimes decisions need to be made right away but you are always in control.

Right now I see emergencies exclusively, when I actually started this article I was doing a lot of dentistry, the parallels are very similar. When someone comes into the emergency clinic I work at right now, we often have to have difficult discussions about the problem at hand, how much it is going to cost to get a handle on the problem and the fact that we need a considerable amount of that money BEFORE we do anything with their pet. One tricky thing about quality veterinary care is that it is really expensive to provide. Our equipment, supplies and training cost just as much as the ones utilized by the health care teams who provide our own health care. The costs are essentially the same for all clinics, so if you are getting a great “deal” at your current veterinarian, I promise they’re cutting the costs somewhere. Our pets have many of the same health problems we do as their owners. And the treatments are also very similar in a lot of ways. One big difference, our patients more frequently need to be under anesthesia in order for us to do a satisfactory job. I’m not going to try to reason with a worked up house cat about, well anything really. Lacerations, porcupine quills, dentistry or even growth removals could all happen with local anesthesia in people, not so with pets. As a result, we have added costs in many areas based on the way our patients respond to care. When we are adding things like anesthesia, we are also adding risk as well, mitigating risk involves gathering additional information like blood-work, chest x rays or blood pressure measurements. This additional information also adds cost. All of it, from running blood-work to walking in the front door, is voluntary, but once we start down that path the veterinarian treating your pet has a responsibility. It is our responsibility to provide you with as thorough a plan as possible to give you the best opportunity to make an informed decision about your pet’s healthcare. What you choose to do with that plan is completely up to you.

If a person were to bring a dog having seizures to a veterinarian and task that veterinarian with figuring out why your dog is having seizures and what could be done about it, That seems like a pretty straight forward issue, make sure it’s otherwise healthy and put the dog on anti-convulsant medication and that should work, right? Maybe. I bet you would be successful most of the time with that approach. At least better than half the time, depending on the factors involved of course. If a client came to me and asked if we could just try medication, I would be willing to consider that approach so long as the client understood that we were taking a risk of missing the cause and potentially making things worse. If all I know is that you have a dog having seizures, the list of possible causes is pretty extensive; infections (viral and bacterial), parasites, toxin exposure, electrolyte abnormalities, congenital abnormalities, cancers, liver disease, kidney disease, metabolic diseases, trauma, nutritional deficiencies are just some of the causes of seizure activity in dogs. The better approach would be to fully examine the dog, discuss with them what the seizure activity looked like, how long it lasted, how often it occurred and how the dog recovered to determine first if it was truly a seizure, what kind of a seizure it was and where our diagnostic testing should start. There will be different approaches for patients in different age groups or breeds for example. Then we would present the dog’s owner with a comprehensive idea of where diagnostics should start and how we can expect things to proceed. In this situation the client can now take all of the provided information, process it and make a better informed decision. They could even take the recommendation, leave, go home, look everything up on the internet and come back with a series of questions for their veterinarian. From that conversation a diagnostic plan could be implemented and they could start down the path towards understanding their pet’s medical condition and needs but in order to get there, we need to present the owner with a complete plan.

One of my least favorite questions to answer when presenting a plan is which part of the plan is necessary. Personally, it bothers me because the idea that I would offer unnecessary testing is the same to me as asking if I’m trying to steal from you. The answer is no. Professionally, it’s a frustrating question because the only appropriate answer is, “It depends.” It depends on what you as the customer wants. Do you want to know why your dog is having seizures or do you just want to try something to see if we can reduce the number or duration of the seizures? Perhaps rather than asking how much of this is necessary, it might be better worded as, what is the minimal amount of information we need to have a reasonable chance at a positive result? Of course the answer to that is also, “It depends.” It depends on how extensive the problem is and what the solution is going to be. Sometimes, even the options available to us are incredibly limited. I still think we can have a satisfactory outcome every time just as long as we are communicating openly and understand what we are doing. Even if we chose the minimal amount of information path, if we communicated effectively,  going down a path with a lot of uncertainty surrounding our issue is alright.

Where we start to have trouble is when the communication breaks down. If we don’t have access to all of the information that makes sense for this problem then it becomes harder to come up with a treatment plan. Without a solid treatment plan we might not have the expected results, they may take longer or we may encounter complications. It’s possible everything will be completely fine but when things don’t get better or take a long time in getting better it’s also very possible that those missing pieces of information would have helped. It doesn’t mean we have to do everything recommended every time or right at the beginning. It means we have to be open and realistic about expectations. And we all have to be on the same page. And we all have to accept responsibility for our own decisions.

In no way am I typing this hoping that you start spending more money at your veterinarian’s office and I would feel awful if you took this to mean that I think you should spend more than you can afford. What I am trying to articulate is that both sides of the exam table are making decisions and as long as they are on the same page and can be frank and candid with one another, I expect every outcome to be satisfactory.

Thanks for reading.

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How to catch a cat in a HavAHart trap

/ heathamc / 1 Comment

My employer shared the letter with me not because there was really anything I could change or that could be done about what had happened. It was more to let me know that she had received it and because it was too good not to share.

A few weeks previously, a couple had brought us one of their adopted feral cats for a bite wound on its back end. They had warned us about how the cat was and told us to be careful with her. We had listened and had found the small gray tabby to be a wonderfully easy patient. She snuggled up on us during her exam and we loaded her in to her carrier without incident when her owners came to pick her up. I find this to be true of many adopted feral cats. They turn into big loves so long as you let them set the terms.

We did the recheck in our Ludlow office. The owner was present for the recheck, she had not been present for the initial visit. I took the feral cat out of her carrier, she was nervous but after some chin scratching she rubbed up against my hand. When I went to lift her up to examine her abdomen the owner tried to intervene. The cat did not approve of the intervention, my response to the intervention or both. She exploded around the room, knocked the blinds off the windows and then hid behind the sink. I retrieved her and finished the recheck. The issue had resolved and would not require any further attention. The feral cat and her owner returned home.

The letter arrived the following week. I don’t remember the details anymore, I had saved it for a few years but must have discarded it recently. The basic premise was that I was an inept veterinarian who didn’t know how to handle feral cats and shouldn’t be allowed near animals. I do remember that the word “idiot” was used eleven times in the one page letter. It was directed at me every single time. Needless to say I was not this client’s favorite veterinarian.

Fast forward one month, exactly one month from the day of that fateful recheck exam. The same owners bring in another feral cat, this cat had just been captured by these feline rescuers and was still mean as could be. It likely goes without saying that they did not want any of the veterinary services to be performed by me. Completely understandable.

Then the cat got loose in the cat ward. Bear with me while I paint the cat ward into your mind. It’s a rectangular room, eight feet wide by sixteen feet long. There is a single door at one end of a sixteen foot wall and two large windows along the other. At the 8 foot wall nearest the door is a treatment table and scale for weighing cats and a cat kennel bay on the other end of the room. All in there are 10 feline kennels in that room. The cat ward also serves as the location for the server and data lines for the hospital so there is a shelf in one corner and a hole in the ceiling for all of the data lines to go throughout the practice.

We attempted to capture the cat but he wedged himself behind the kennels against the far wall in the cat ward and would hiss and strike at us as we tried to get him out. Fortunately, the kennels are on wheels so I wheeled the kennel away from the wall and climbed on top of the kennel to get at the feral cat. The plan was to corner the cat on one side of the space behind the kennel by advancing a broom towards him. Once he was in a position he could not bolt from I was going to jump down, throw a thick towel over him, scoop him up and return him to his carrier. Seemed easy enough.

Instead of being cornered, the cat decided that it was fighting time, he attacked the broom that I was advancing towards him without any semblance of fear. My plan had been to use the broom to guide him gently out from behind the kennels, his plan had been different. Once he latched onto the broom and realized it was good for climbing, it took less than a second for him to be crouched next to where I was laying on top of the kennels. We locked eyes. I sat still watching him as he glared at me, waiting for him to attack me. Instead he hissed once in my face, turned and jumped up through the hole in the ceiling and was gone. I sat for a long moment in silence. All I could think to say after that moment had passed was, “I can’t believe that actually happened.”

I got down from my perch and went to the hatch that led to the crawl space attic above the cat ward, stood on a stool and shined a flashlight inside. Two glowing green eyes peered back at me and after looking around the small crawl space, I decided he didn’t have much room to hide and I could probably capture him with the net. So I climbed up into the crawl space with a four foot long loop net and planned to capture the escaped feral cat. I was of course, wrong. The crawl space had roughly one million tiny places for a feline to fit that a human might not even see let alone climb into. And it was approximately 1000 degrees Fahrenheit in there. After a few minutes up there, I retreated to the safety and comfort of the treatment area and thought about what to do next.

We decided to set a catch and release trap with some cat food in the attic and wait until morning. My boss told me she would call the owners of the feral cat when she arrived at our Ludlow office for afternoon appointments and explain everything to them. That seemed fair, I hadn’t even lost the cat. I was just trying to be helpful. What we didn’t take into account was that we were at the tail end of road construction season here in Vermont and the commute took her considerably longer than usual. As a result, appointments started a little late in Ludlow and she struggled to keep up. In Rutland, the owners of the feral cat stopped by to pick up their cat.

I must have rehearsed what I was going to say to these people fifty times in my head before I stepped into the cat exam room. I was going to explain to them that I (the veterinarian they called an idiot in the letter they wrote to my employer) lost their feral cat in the ceiling of our practice. Then I was going to get out of the room. As soon as I closed the door behind me, my mind went completely blank. I stood there for what felt like an hour before I decided that I had to just go for it.

I do not remember a word that I said to them or a single word they said to me but I do remember that they didn’t smile. Not once. They left and we set a HavAHart trap with some canned cat food up in the attic.

You can get your own here: HavAHart

The next morning the cat was in the trap. We called the owners, they picked up the cat and we never saw those cats or their owners again. I saved the letter for years but apparently discarded it recently. I suppose I am ready to move on.

Thanks for reading.

Best Roomba for Pet Hair!

Never Hear Wolf

/ heathamc / 1 Comment

Being a veterinarian here in Vermont is pretty awesome all of the time. There are two seasons that are especially awesome to be a vet here; Winter and Summer. Both seasons bring in tourists and both seasons are a little bit slower for our regular clientele so we can focus on catering to our out of state clients without feeling like we are ignoring our regular folk. It’s a really fun situation. Also, I like skiing and swimming. Not at the same time of course.

I am using three out of stater stories to illustrate the importance of taking to heart the complaint a client calls in with.

1. It was the first July I was in practice. It was hot and my wife and I had only recently found out we were expecting our first child (we didn’t know it was a girl until she was born.) My in-laws were visiting and we were living in East Dorset at the time. There was a great little pick your own berry farm just down the road from us. The afternoon plan was, we were going to pick some berries then head down to Emerald Lake State Park for a quick swim before grilling some dinner on the deck. It was going to be a pretty sweet New England summer afternoon and night.

But I was on call and of course my phone rang as we were headed into the berry farm. I took down the client’s information and called while I was finding a parking spot. It was legal to use a hand held device while driving at this point. I might be the reason it’s not anymore. The client was visiting from Connecticut and their Labrador Retriever puppy had been spayed the day before. There was a problem with the incision. I called and the woman owner – a pleasant but slightly frantic pet owner – answered. She informed me that her dogs spay incision was open and she was pretty sure that she could see intestines.

I was fresh out of school, young and at least as excited about veterinary medicine as I am today. I told her I would meet her at the hospital right away. I told my wife what was happening and she – infected by my enthusiasm – agreed to walk the mile back to our house. In the heat. Pregnant. I left in a hurry and made the drive from East Dorset to Rutland in 19 minutes. Google map that. This story will be here when you get back. I have a client who is on a police force in Southern Vermont and lives in one of the towns I drove through way too fast. I am sorry. I am glad no one got hurt.

I pulled into the driveway and was kind of excited that I beat the client there. I got out of the car, grabbed my keys and went to unlock the door. Then I caught a glimpse of myself in the reflection in the window. I had on board shorts, an athletic shirt and flip flops. (Relax OSHA I have Crocs in the clinic (relax fashion police I’m a veterinarian I’m supposed to look terrible)) I wondered how anyone was going to take me seriously. I threw on a pair of scrubs and my Crocs.

The client arrived and I led them into the exam room. I carefully asked the dog to lay down and had a look at her incision. I’m not sure what I was expecting but I did my best to hold in a laugh, told the woman that the incision edges were just a little swollen and there was a small strand of subcutaneous fat that was poking through the edge of the incision. To ameliorate her concerns, I applied a bandage and told her she could remove the bandage in 24 hours and could apply an antibiotic ointment twice daily until the incision was healed.

2. The second incision emergency was in a Labrador Retriever visiting the Ludlow area from New Jersey one Winter. The owner carried her in as I was finishing appointments one evening. I remember it being already dark so here in Vermont it might have been just a little past noon on a Winter day. The dog had been spayed a few days previously and her owner was adamant that the incision had opened up while they were out snowshoeing that morning. A brief six mile snowshoe adventure in some fairly deep and fresh snow. He also mentioned that he was taking the dog cross country skiing tomorrow and that the dog’s intestines were poking through. In the same sentence. Both of those statements can not be true.

I took a look and he was half way correct, the incision was open a small amount at the very top of the incision. The intestines? No that turned out to just be an extra long suture tag from the closure. I trimmed the suture back a bit and encouraged the owner to apply a small amount of antibiotic ointment to the open part of the incision until it healed. And to try to tone down the exercise for a week or so.

3. Ah the rule of three. Also known as the comic triple. The third call came in the Winter as well. A young couple from Massachusetts had brought their recently spayed Labrador Retriever – a recurring theme in incision issues all around – with them on a ski vacation. One of their friends had come along with them and was watching the dog while they were enjoying a sunny and warm ski day. We got the call on a very busy Saturday morning. Labrador. Visiting from out of state. Spay incision is open. Something was sticking out. I told the receptionist to have them come right in. I remember turning and looking right at the two technicians we had working that morning and making a joke about it needing a good application of antibiotic ointment. I remember having a brief conversation about telling them to wait until they got home to their vet in Massachusetts because we were so busy. We decided to play it safe and that it would be quick and easy. I would probably just step out in the lobby, look, tell them it would be fine and would send them on their way.

All of our smiles and laughter disappeared when a trembling, nervous black lab was led into our treatment area. I could tell from where I was standing that something was wrong. Yes, I’m pretty good at recognizing problems but also she had something that should have been in her abdomen trailing behind her on the floor. So it wasn’t too hard. I could not tell if the dangling bit of innards contained intestines but it was large and starting to smell a little putrid so at that point, anything was possible. I was pretty worried about this little puppy. On top of that she was justifiably upset and nervous. We couldn’t get her to hold still for much more than a physical exam and even then getting a temperature was an exercise in futility. I desperately wanted to sedate this dog and determine how bad the issue was and what needed to be done as soon as possible. But the owners were still skiing and not answering their phones. Megan, one of our technicians sat with the puppy and tried to keep her calm until we got in touch with the owners. I carried on with appointments, putting the distressed little puppy out of my mind as much as I could while I examined other pets and addressed other concerns. Finally about an hour after the initial phone call, the owners called and gave me permission to sedate their dog. They were coming right down from Killington which is about a half hour drive from our practice on River Street in Rutland.

We sedated the dog and examined the incision and the abdominal contents coming out of the incision. A small amount of the omentum which is a lacy blanket of fat that covers and protects the abdominal organs was hanging from a very small hole in the abdominal incision. Fortunately, there were no intestines and just a few blood vessels associated with the omentum protruding from a two inch long section of open incision. By the time the owners showed up, I had the problem figured out and a solution worked up. We went over the plan, the costs and the expected recovery. We agreed on everything and we took the dog into surgery immediately.

The technician working with me in surgery, Alex, would feel like I was leaving a little bit out if I didn’t inform you that the surgery was not straightforward. During the removal of all of the omentum that had been outside the body a large artery was inadvertently transected with the needle attached to our suture material. The resulting bleeding was fairly remarkable and it took some time to get the bleeding stopped, clean away all the blood and be certain that the bleeding was not going to come back. We had allotted an hour for surgery and all in the procedure took us a little over two hours.

We had a few appointments we had to reschedule due to taking the surgery into overtime. So on top of a stressful and exhausting surgery, I had to make a bunch of apologetic phone calls while waiting for the lab to recover from anesthesia. The puppy recovered and we ended up sending her home later that evening. The puppy went on to make a full recovery.

I’m glad I had the puppy come right in. I’m glad I didn’t give in to the pressure of a busy day and the past experience of false alarms. Asking them to wait until Monday would have been a disaster. Hopefully they wouldn’t have followed that recommendation but more importantly, I’m glad I didn’t make it.

I hope that life will continue to throw enough of these experiences at me so I don’t get complacent or comfortable enough to start taking my clients concerns less seriously than they do. At least not until I confirm that the exposed intestines are actually just suture material.

Thanks for reading.

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How to pull porcupine quills out of your dog.

/ heathamc / 4 Comments

They are about the size of a large cat, near sighted and they don’t run. Instead they sort of dreamily lumber around in the dark making odd grunting noises and barely acknowledging you if you follow them around with a flashlight. I like to think of them as beavers who joined a punk band, got burned out on tour and are returning back to their roots.

Unfortunately, your dog likes to think of them as giant chew toys. To be fair, it probably does seem like a lot of fun, a waddling big rodent that rustles when you get too close. To a dog that probably seems irresistible. I imagine that the thought process in a dog encountering a porcupine goes something like this, “Oh man, this is going to be awesome, it’s wiggling at me this is going to be so much fun!” Smack “Oh man, this is pretty terrible, I’m not having any fun.” But there are always repeat customers. We had one dog come in four times in the same Spring for quills one year. Depending on the client, I will often relate it to tequila and college students. It’s one of those things that seems like a great idea and a really good time and then suddenly, it’s no fun anymore. But they often go back another day for more.

Dogs almost never get into porcupines first thing in the morning. It’s usually evening, you’re letting them go out for one last pee before bedtime, you’re half asleep while you stand at the door after you let the dog out and he or she comes back with a face full of quills. Well great. Now what?

The following instructions are only intended for people who are within an hour drive of the developed world. If you find yourself a day’s hike out in the wilderness and then your dog gets quills there you can skip the steps and go to the bottom. If you’re that far out in the wilderness and don’t have a hemostat. Shame on you. Be more prepared next time.

Steps to removing quills from your dog:

1. Call your veterinarian. Darn it. You thought I was going to tell you how to do this at home. Did you forget I’m all about the money I can make from clients? Seriously though, porcupine quills are no joke. Here’s an article explaining their shape and why pulling them out awake might be a terrible idea. It’s at least worth a phone call to speak to a veterinarian and explain the situation. Calling the vet should always be free.

2. Follow your veterinarian’s instructions. For one or two quills, I might have you try to pull them at home. Sometimes even one or two quills requires some form of restraint and professional attention. If there are quills in the mouth or quills around the eye or especially, quills near the shoulder area I will always recommend we remove them for you. Always. These evil little buggers are composed to move in a single direction. Usually they migrate out to the surface but not always. Scroll to the second to last paragraph of this article to see what I mean.

3. Be ready for this to take more than one episode. If your dog does a good enough job on the porcupine there may be quills that we can not reach on the first go round. As these move toward the surface, sometimes a separate procedure is necessary to get everything out.

If your veterinarian told you to try to pull them at home or you are out in the wilderness please open this photo in a separate window. See the tool this person is using to remove them? You need a tool like that, pliers might work but hemostats are better. “But Heath, I don’t have hemostats.” Here’s a pair for less than $15. Hemostats

If you’re spending time in the woods these would come in handy in multiple situations. If you fish, even more so. Look back at the photo. Grab the quill down in the dark section and pull straight back to remove it. One quick motion, no twisting and no bending. If your dog bites you during this, that’s on you. Sorry. That’s one reason why we sedate them.

If you’re unlucky enough to find your dog with quills, give your veterinarian or local veterinary emergency clinic a call. And if they do it once, chances are they will do it again.

Thanks for reading.

Amazon Echo Dot

How to communicate perfectly.

/ heathamc / 5 Comments

You can’t. That doesn’t mean you shouldn’t bother trying to.

I don’t know how to communicate perfectly but over the past few years and especially over the past few months I am starting to understand the keys and the benefits to effective communication. While I approach it from a veterinary/client point of view I imagine these points can be applied to nearly every relationship you have. Heck, I apply them to conversations with my three and four year olds as well. In the spirit of being a cliched blog fit for social media sharing, I am going to share my top five points on effective communication.

Be Honest. I mean honest when it hurts the most. When you just want to tweak the details a touch or leave out one piece of the story. Everyone feels like they are an honest person and I’m sure you are but there are those times where you might “spin” an issue or withhold a small but possibly critical piece of information in the hopes that whatever you are trying to communicate isn’t bogged down with concerns from the receiving party. In my world and practice it often goes like this, Fluffy is having problems a, b and c. To get close to an answer and formulate a treatment plan she needs testing x, y and z done. Then once we have that information we will be doing something. What I often find myself guilty of glossing over is the money part. If you’ve read my posts on this subject here or here you might understand that I am starting to get more comfortable with the fact that my services cost money. If you ever read my previous blog you might see how far I’ve come. By not fully preparing one of my clients for the costs associated with our services, I am not being one hundred percent up front with them. If someone is surprised by their bill at the end of a visit, I haven’t communicated effectively. It still happens to me but I’m getting better. The other area I think honesty can get a little cloudy is when people ask questions we don’t know the answer to. I remember telling someone I didn’t know what was wrong with their dog once early in my career, they went elsewhere. You can imagine how I felt about telling another client I didn’t know what was going on with their pet. Somewhere along the way I figured it’s just less stressful for me to be honest than to seem like I know everything. And then something amazing happened. I somehow found a way to explain things clearly enough so that people understand, it’s not that I don’t know what’s going on, it’s that what is going on is more complicated than it seems. Pets are really complex little systems and a lot of things can go wrong and cause very similar issues. By telling them I don’t know right now, it went from them thinking I had no idea what I was doing to them being able to appreciate how unique their pet’s problem was. It made communication easier and kept the lines open which always allows us to at least reach a point where everyone is satisfied with what we can or can’t accomplish.

Listen. It’s the most important and often the most overlooked part of effective communication. How can you convey the information the other person needs if you don’t listen for the parts the other person doesn’t understand? I try to spend less time talking in the exam room than the client. With some clients that is really easy, with others it can be like pulling teeth. It’s even worse on the phone. But when you stop and listen to what people are saying you find you are much better at providing them with excellent service because you actually understand what they want. It’s worth a lot to know what people want from you and when you can deliver it and see the results, it will really reinforce the benefit of you shutting up a little more often and listening to what people have to say. When I first got out of school and started practicing, there was so much information to convey, how was I going to get it all out and in a way people would understand? I needed to teach them how to take care of their pets. Wait, what? No, I had it all wrong. Yes, often people come to me with issues they want my expert advice and assistance with, that’s my job. But most of the time, people want me to provide the services they would like for their pets. And in order to know what those services are and to provide them effectively, I have to listen.

Slow down. If you’re talking so fast that someone can’t understand you or can’t get a word in edge wise, you are not communicating effectively. Think about an evening out with friends, everyone has a few adult beverages and starts telling stories. You have a great story that fits right into the conversation but by the time there is a space in the chatter the topic has moved off so much that your story seems out of place and kind of silly. A simple and amusing part of a night spent with friends, not so amusing when trying to communicate with your veterinarian about your pet’s health. Tied in to the problem I had early on with listening was in trying to get all of the super important information I needed to share with my new clients I would just blurt it all out whether they were listening or not. I would rattle stuff off so fast people were probably thinking that I was auctioning their pet off like livestock. Looking back I’m surprised no one ever made a bid. While I don’t currently speak with the same number of pregnant pauses as President Obama, I do try to stop talking for a few seconds every time I am changing the subject or about to make a recommendation. People deserve a chance to disagree or interrupt you and let you know what they are thinking. Also, you are going to be way more effective if people understand you. So slow down, catch your breath. Give the other person a chance to talk and tell you what they want. Especially on the phone. Stop making every phone call a race to hang up. Take the time to have the conversation. You’ll be amazed at how much better your service or outcome is.

Less filler speak. On of my least favorite things to hear when trying to communicate with anyone is a barrage of filler speak. Works such as; like, you know, basically or the uhs and ums of communication get in the way of allowing open communication and road block the other person from having a say. The author, debater and contrarian Christopher Hitchens put it nicely in his article for Vanity Fair, The Other L-word,  “People who can’t get along without “um” or “er” or “basically” (or, in England, “actually”) or “et cetera et cetera” are of two types: the chronically modest and inarticulate and the mildly authoritarian who want to make themselves un-interruptible.” Try to replace your filler speak with silence and you’ll be amazed at what people would like to say if only you’d give them the opportunity. I haven’t really ever been guilty of a lot of fillers in my conversation but it’s similar to talking too fast or omission. There have been times, I am afraid to admit, where I knew something needed to be done for someone’s pet but if I gave them a chance to start digging at my recommendations I might have given them the chance to talk themselves out of following through with them. So I talked too fast, didn’t include all the details and got the job done. Foreign body surgeries used to be like this for me. I see filler words used in much the same manner, they fill in the gaps that should otherwise be replaced with details or with a pause to give an opportunity for rebuttal. So again, shut up a little bit. Stop steam rolling the people you are trying to communicate with with ridiculous non-words and see how much better your communication skills get.

Let the other person end the conversation. If you are the one making a recommendation, providing a service or trying to convey information, the other person is the customer. They chose you out of all of the other options to help with their problem and they are working with you and letting you do your job. They get to decide when the conversation is over. And they will, trust me. No one wants to be on the phone longer than they have to, no one enjoys being stuck in your windowless exam room. You’re not that entertaining. But giving them the chance to say everything they wanted to say leaves them satisfied and if you need me to help you understand the importance of a satisfied client or why having people enjoy communicating with you should matter to you, this blog isn’t for you.

Most importantly, communication is a skill. Like any skill, you will have good days and you will have bad days but as you work towards your goal your skill set will improve. Over time. Don’t try to rush these things. Take the time to master the fundamentals and then work on the implementation and make it your own. Remember, “slow is smooth and smooth is fast.” Baby steps. You’ll get there and you’ll like the results.

Thanks for reading.

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Euthanasia Aftermath

/ heathamc / 15 Comments

I struggled with writing about this situation. I struggled with posting a blog about it. Please try to understand.

A few weeks ago a very good client of mine passed away unexpectedly. She had a little toy breed dog who had been battling some significant but non life-threatening medical issues for the past few years. We had developed a fairly good client-veterinarian relationship and the little dog had gone from being terrified by my presence to being quite happy to see me. I always did have a pocket full of cookies for him after all. Quickest way to a dog’s heart.

I was notified on Wednesday of the woman’s passing and the daughter set up a visit for the coming Friday to have the little guy put down. Apparently, no one in the family could take the dog and with his medical conditions the owner had left instructions to have him euthanized rather than have him surrendered to a shelter or rescue group.

I expressed some concern about the visit when it was scheduled and my employer and I discussed the dog’s history. He was 13 years old, had multiple health issues and could be aggressive when he was not feeling his best. We foolishly decided that I would have a conversation with the owner’s daughter when she brought him in for his visit.

The morning of the visit came. Not that these details are important but they play into the narrative so bear with me. My family was planning a trip to visit my wife’s family in New York. When we do that, I typically drop everyone off in the morning and then pick the kids up from daycare and then get my wife from work so we don’t have to leave a vehicle at her office over the weekend. As would be expected when you are getting five people together for a weekend away from home, I was running late that morning. Veterinary medicine is one of those professions where if things start getting a little out of hand, it snowballs quickly and getting caught up can be a challenge.

I arrived at work to a fairly busy appointment schedule. I am pretty decent at compartmentalizing my work, so there was no thinking about the four hour drive I had ahead of me until 4:30 that afternoon, but also when I’m in an exam room with a client, that’s all I think about. I didn’t plan ahead as much as I would have liked for the euthanasia visit coming in at 10:00 am.

The time came and a very distraught woman brought in a happy but slightly disoriented little dog. The woman was sobbing, able to get a few words out about her mother’s wishes and was in no place to discuss other options. We fell back on our training and guided the woman through the euthanasia process. We put the little dog to sleep and prepared his remains for cremation and because we were running behind schedule we went right into our next appointment. For some reason I feel like it’s necessary to inform you that this whole process took nearly thirty minutes and as we were preparing out back we weren’t happy about it but at the time I did not see a reasonable alternative.

I went for a walk that lunch break to process my thoughts, something was weighing on my mind. My wife called and she was in the middle of a pretty difficult situation and having one of the worst days a veterinarian can have. Little did either of us know she was about to have the worst day she has yet experienced as a veterinarian and in my opinion the worst kind of day a veterinarian can have. Not that that particular detail is important but it plays into the narrative.

I got back from the walk just in time for the first appointment of the afternoon. With appointments and callbacks I didn’t have a chance to even think about anything else until I got in my car that afternoon. When I got in the car I was on a schedule. I had to get home, pack the car for the weekend, I had a list of chores that needed doing before we left. The dogs had to be fed and they needed to do their business before we took off for a four hour drive. I packed the car and picked up the girls. We (they) talked about their day from the daycare to the practice my wife works at. Once at my wife’s practice we started discussing her day and it was such a horrible day the conversation took up a good section of the drive. It wasn’t until we were on the thruway, there is this place on the right hand side when you’re heading south that has log cabin homes on display it was there that my own thoughts started creeping into my consciousness. Like fog settling on a highway at night, they did not bring with them anything good. By then my wife was trying to get a nap in and I was left alone with the radio. I started playing back the day in my head and was overwhelmed with grief as I thought about the small dog I had euthanized that morning.

I still think about him a little bit almost every day. These are the thoughts that run through my head: I wonder if I had brought him home how long he would have really had left. I could have brought him everywhere with me and I’m sure eventually my wife would have come around. I’m just manly enough so that carrying a small white dog everywhere would have looked cool or ironic. How many times in my career is something like this particular situation really going to happen to me? This could have been a once in a lifetime opportunity to make a dog’s life a little better and I missed it. Not only did I miss it but I was the instrument that ended his life. I wish I’d had more time or had reached out to the owner’s daughter a little earlier. Maybe she would have been adamant that we follow her mother’s instruction but maybe we could have come up with a solution together. I’ll never know.

Self pity aside, this is not a situation that is all that unusual in veterinary medicine. We are often faced with the request of euthanizing a pet for reasons many people might disagree with. The idea of euthanizing a pet to meet the request of an owner after they have themselves died is also not that unusual. It happens. At one point in my career we had a patient whose owner had left him a trust fund and the remaining inheritance wasn’t to be released until the pet passed. You can imagine how the lawyer felt about those veterinary bills. But ultimately, decisions like this are always going to be a part of this profession. Some of them will be a struggle and some of them won’t. This one was and still is. I don’t think that the owner’s family did anything wrong by him, I just wish it had played out differently. Hoping there’s not a next time.

Thanks for reading.

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