Wedding planning

It's hard to believe D and I are getting married in a little over 4 months. Our to-do list is still extraordinarily (frighteningly?) long. Toward the end of September we’re headed to the wedding site to meet with the coordinator and some vendors.

We decided to get married in the mountains since we met through a ski club and because we love skiing and snowboarding so much, but the distance makes planning more challenging. We chose a resort that provides a package deal and a coordinator to handle a lot of the details. It means fewer choices of vendors, but that’s okay. I’m personally only picky about food (including cake!) and music. As long as the officiant isn’t offensive and as long as we get some pictures taken I don’t really care who does them.

Wedding websites are hilarious though. They could definitely make you crazy if you took every suggestion seriously. For example, one website recommends that you come up with a “signature cocktail” and serve it at your reception. More power to you if you want to do that, but that’s so not me.

I do have my dress and accessories, though! That part was pretty easy because I've had 38 years (!) to contemplate what I like and don't like.

I didn’t expect to be BFFs, but

Today was a moderately busy day at my “home” hospital (which equates to a slow-ish day at my "training" hospital). I worked with a colleague – let’s call them Dr. T.

Up until today when I have worked with Dr. T it has been SLOOOOOOOOW. They seemed fairly quiet but overall okay.

Not today.

Dr. T got behind on surgeries (and was freaking out during said surgeries over a million little things). There were also drop-off patients to be seen.

Me, after watching one surgery I hadn’t seen before (which a specialist came in to perform): “Hey, once this surgery is done I can start on the drop-offs while you keep going on surgeries.”

Dr. T: “I can help you.”

Me: “Okay.”

Then, while Dr. T’s next surgery patient is on the table ready to be induced, s/he decides to deal with 2 drop-off patients. Then s/he dithers about whether or not to deal with one of those 2 drop-off patients and asks me to take it. I say yes, then s/he says “No, I’ll take it.”

WTF?

Then 5 minutes later Dr. T asks me to take that same patient again, saying “because I can’t be doing everything.”

Again, WTF??

I’m pretty sure I didn’t give a look or other indication that I didn’t WANT to take that patient.

So I take that patient AND all but two of the drop-offs AND several more appointments while Dr. T hovers over a dental cleaning (that s/he is not performing, s/he just gets “nervous” about anesthesia and hovers THE ENTIRE TIME even though RVTs are there!)

Then while I’m in yet another appointment, s/he asks me if I’m already in an appointment and if I could take one that just rolled in.

At this point I said “Yes, I’m with Fluffy right now. Would you like me to take Spot as well?”

S/he took that appointment after all.

I have no tolerance for passive-aggressive types. Don't say you can take something and then play it like I'm slacking.

I’ve decided screw it – no more trying to be nice and defer to the “senior” doctor by asking if s/he wants to take an appointment. If one comes in and a tech asks who can take it, I’m your girl.

Of course I guarantee that Dr. T will get pissed off about that too.  Fortunately I will only have to work with them one day a week going forward.

New Schedule

Next month week I officially, officially start full-time at my “home” hospital. There is one other doctor and myself, and we’re working 4 days per week, 10 hours per day. Realistically it’s more like 11 hours per day because we almost never take a full hour for lunch.

Of those 4 days per week, I’m the only doctor for 3 of them. I’m a little bit nervous but think I’m ready. If it were my training hospital I’d be crapping my pants because that place is a LOT busier.

Back to the shelter?

Yesterday I met with the volunteer coordinator from the shelter where I used to volunteer (and later work) before going to veterinary school. We talked about possible help they might need from a veterinarian including performing surgeries, assessing sick animals, and prescribing treatments for them.

I’m pretty excited to get back volunteering for a couple of reasons. One, I firmly believe that volunteer work is good for the soul. Two, it gives me a change of pace and perhaps a chance to practice different skills (high volume surgery, infectious disease management) than I would at my day job.

The people I met seemed SUPER excited at the prospect of having me back, which was flattering and also a little weird because I didn’t feel very valued as an employee there. (That could have been due to weird politics and the way the organization was set up – who knows.) At any rate, a couple of the people-in-charge hinted at me potentially working there again. Also flattering, but unless the politics have radically changed there I’d rather just volunteer and stay out of that mess, thankyouverymuch.

(Trying to) Eat Healthy

For the past 2 weeks I’ve changed my eating habits. I’ve been cooking all but 1 meal per week at home and have cut out potato chips, candy, and (except for 1 time) soda. I haven’t gone completely Paleo like a lot of Crossfitters do, but my grain/bread consumption has gone way down also (2-3 servings per day instead of 6-8).

Not gonna lie, it’s been really tough. The first couple of days I had a dull headache all day. I suspect it was due to withdrawal from something (Sugar? Junk food in general?) Eventually that went away, thank goodness.

It’s also more expensive and inconvenient to cook at home. I’m spending about 1 ½ times more at the grocery store to get fresh produce and real food vs. boxed and canned starchy pre-packaged meals. I’m also spending about twice the time preparing food – prepping veggies, cooking large quantities of meat for the week, etc.

I think it’s worth it – I feel a lot better now. I’ve also lost a little bit of weight (that wasn’t a primary goal, but anything that helps me with achieving a pull-up is all right by me!)

A Study in Contrasts

Sunday:

Worked at my training hospital

Saw 18 patients – 10 sick, 8 healthy(ish)

1 surgery (spay on an older fat dog – ugh)

Worked 9 hours

No potty breaks, no lunch breaks – just straight madness all day

Monday:

Worked at my “home” (destination) hospital

Saw 11 patients – 4 sick, 7 healthy

No surgeries

Worked 9 hours

Sat around a LOT and got very very bored

I’m not entirely sure why the days were so different. I think it’s because at the training hospital I end up haggling a lot more with clients about treatment plans so every appointment takes longer, but I can’t prove that.

Fear

After working as the only doctor in the hospital the other day, I suddenly became much more confident at work. I stopped shying away from appointments that looked like they might have difficult medical problems, difficult clients, or both.

Before, in the way back of my mind I would think something like this:

"I’ve never seen a case like that before. I have no idea how to treat that! Besides, they’ve seen Dr. G before so it’s probably better if she sees them again, right? What if I screw it all up and kill the pet/get sued/lose my license?”

I guess working by myself was the most frightening thing I could think of and once that was over I realized I could handle a lot more than I previously thought.

Today at Crossfit I noticed the fear getting in the way again. We were working up to a 1 rep max split jerk. I easily lifted 65, then 85, then 95 pounds. My previous best was 95 pounds, so once I added on 5 more pounds for 100 I suddenly struggled. I could get the weight up high enough to get under it but didn’t drop under the bar.

I’m pretty sure the back of my mind was saying something like:

“Oh crap. 100 pounds? That’s really heavy. What if I drop it? More specifically, what if I drop it ON MY HEAD?”

I talked with the coach about it and he had great advice – STOP THINKING. So I did, and boom – lifted the weight.

It’s really amazing how your mind can either help or hurt your performance. I used to think all those quotes and sayings about attitude were silly. Not anymore.

p.s. I also set a PR on the push press and the snatch (don’t laugh) this week!

Sad cases

The pancreatitis dog came back a few days later for euthanasia. He (predictably, since he had virtually no treatment) looked like crap.

I also had a kitten come in for lethargy the other day. I found a kidney the size of Texas. History and clinical signs appear to be consistent with FIP; titers are pending. (I happen to especially hate FIP after losing a foster kitten to it. It’s a horrible disease that kills young kittens and cats. There is no cure and no way of predicting who will get it.)

On my own

So I walked into work this morning and the practice manager said “Doctor, we need to send you to the hospital in City Z because their doctor is sick and they have no doctor.”

Whaaaat? I’m still in training right?

I expressed my reservations (quite diplomatically) about handling an ENTIRE clinic on my own so soon, and the practice manager assured me that the other hospital wasn’t that busy, that the area managers approved it, and everyone totally thought I could handle it.

I then drove another 15 miles up the road to City Z while trying not to crap my pants.

As it turns out, the day went fine. I had two moments of big panic:

1.     Afternoon appointment, cat had been seen the previous day. Clients PO’ed about the bill exceeding the estimate yesterday and that all of the problems weren’t fixed yesterday. (It turned out to be a cat bite abscess which I got to lance and place a drain – yay!)

2.     Case from yesterday calls wanting to do a recheck and follow up. Problem is, they’re in City X and I can’t access City X’s appointment schedule or anything. After several phone calls we agreed that the client would come to City X tomorrow when I’m back.

I also learned how to use the controlled drug log (until now I haven’t had my own lock box to deal with). Yay?

Introversion in a service industry

A lot (possibly the majority?) of people who become veterinarians are introverts, myself included. There was a great message board discussion on VIN the other day that got me thinking. How do we reconcile our introversion with a clinical job where we are dealing with dozens upon dozens of people every day?

For me, I’m always just the tiniest bit nervous when I am driving to work. I almost have to put my game face on every day. You know, the happy, smiling, patient teacher (because let’s face it – we’re teaching people why they should spend their money on a test or treatment, how their pet got messed up in the first place, better caretaking techniques ...) who is full of energy.

The truth is, until I actually get in the room with the client I’m nervous. Every. Single. Time. Once I’m in there and we’re discussing their pet, it’s fine.

All of this forced interaction with others makes me exhausted at the end of the day. I often sit in front of the TV with a blank stare – I don’t even really want dinner. I’ve had to start working out before work and on weekends. Socializing? Ugh – unless it’s with people that I already know pretty well.

What I’ve found out is that I need time alone to recharge after being around so many people. Once I have that “zombie time,” as I call it, I can get up and do it all over again.

A wedding and a workout

Yesterday my friends D and S got married (Mazel tov, guys!) It was great to see my friends from vet school and to catch up with them. Everyone seems to be settling in well at their new jobs. It was nice to know that other people also have moments of sheer panic (oh-crap-I-have-no-idea-what-to-do-for-this-pet) and moments of triumph when we actually solve a problem or master a new skill. It was also bittersweet because everyone is so busy (especially those who are doing internships) and so geographically scattered that we aren’t in touch very often anymore.

The ceremony itself made me cry like 3 or 4 times (damn you, D, and your beautiful vows!). At the same time I was taking mental notes about all of the details we haven’t figured out for our wedding yet (coming up 5 months from tomorrow!)

After all of that socializing I wasn’t in the mood to go to Crossfit this morning and do the team workout that was on the schedule today (yes, big introvert over here) so we went to Body Pump at a different gym. I haven’t been to that class in at least a year. I’m definitely much stronger than I was, which is great, but the class was still challenging at times.

Mixed results

I saw a really interesting case today (exhausting, but interesting).

Geriatric dog, recent anesthesia event, chronic vomiting (since the anesthesia event), unable to keep food down. History of eating people food, including bones.

Physical exam: dehydrated dog, painful abdomen, just plain looks sick

My differentials: Pancreatitis, GI foreign body, some sort of organ dysfunction (kidneys/liver/etc.), possibly neoplasia (cancer) or Addison's disease

My recommendations: Abdominal radiographs and bloodwork

Let me put this as diplomatically as I can. The client was an a-hole uncooperative and wanted to argue every single line item with me (despite having enough funding to pay for a week's worth of hospitalization at a gold-plated teaching hospital).

1 hour later, I finally get agreement for radiographs. I look at them and my suspicion of pancreatitis increases (the cranial left abdomen had poor serosal detail and there appeared to be widening of the gastro-duodeneal junction).

30 minutes and a LOT of effort later, I get agreement to run a (< $60) snap cPL test (a blood test that can help to confirm my suspicion of pancreatitis). It is positive.

I then spend another 30 or 45 minutes going around and around with the client about treatment. They very reluctantly agree to my plan Z and go out the door still grumpy.

On the one hand, I’m happy that my suspicions were correct and I actually found an answer! On the other hand, the client interaction left a lot to be desired. I’m not-so-secretly hoping that they don’t come back for a recheck.

Ashamed

Here’s a dirty little secret that I’ve only admitted to myself and to D. I hate to tell people what clinic I work at. You see, corporations are viewed pretty poorly in the world of veterinary medicine. They are discussed as evil soul-crushing new grad sweatshops that oh, by the way, are so rigid in their policies that even a monkey could do the job there ‘cause it’s dumbed down so much. The type of veterinarians who go to work there are often talked about as a.) money grubbing, b.) stupid, or c.) a poor unfortunate soul who just couldn’t find anything better.

I don’t think that anyone would say that I’m stupid or money grubbing. I just don’t want anyone to feel sorry for me. I CHOSE to restrict my job search location in order to be with D (my soon-to-be-husband). I CHOSE to not apply for internships. I CHOSE to take this job offer because – let’s face it – pickings are VERY slim in my area. The only people I know who have gotten non-corporate, non-internship jobs have had to move to somewhat rural locations in order to do so!

Clients

The kinds of clients that veterinary school prepares you for:
- The angry client
- The grieving client
- The skeptical client
- The client who talks on-and-on-and-on-and-on
- The client with no money

The kinds that veterinary school couldn't possibly prepare you for:
- The stoned client
- The (mentally) developmentally disabled client
- The client who doesn't speak English, Spanish, Mandarin, or any other language that you or the techs or receptionists speak
- The client with a brain injury who can understand you but can't answer you with anything except "yes" or "no"

True story - I've encountered all these and more in less than 1 month!

Team workout

Yesterday we had a 2-person team Crossfit WOD (workout of the day):

60 deadlifts

50 thrusters

Run/walk 300m carrying the barbell

30 push presses 

20 pull-ups

Run/walk 300m carrying the barbell

Row 1k

We used a 65 lb barbell and finished in 20:50. The thrusters and push presses were the time killers. Other people were slamming through them MUCH faster than we were! I wasn’t unhappy, though, because I’ve been using 55 lb for thrusters and push presses up until now.

Thrusters are the devil, though. I’m pretty sore today.

Ridiculous Saturday

Yesterday I worked my first Saturday. I’ve been working Sundays pretty consistently and they haven’t been too difficult. Saturdays are a whole different ball game, my friends.

To put this into perspective, the goal of my training/mentorship period is to be able to see 12-20 patients per day.

I saw 27 (28 if you count a suture removal).

To make things even more interesting (ha), very few of the cases were straightforward wellness and/or vaccine appointments. They either had extra medical problems, crazy owners, or both. At one point about 2 hours into the day I became so overwhelmed I had to sit for a minute to keep from bursting into tears.

On the one hand, it is reassuring to know that I can handle that kind of volume. On the other hand, I wonder what mistakes I must have made in all that madness and I wonder if my sanity can support regular days like that.

The practice manager assures me that the hospital I am headed to will not be as busy as this one. Let’s hope so – or let’s hope my efficiency improves a LOT very soon!

Joining the corporate world (again).

I decided to take a job offer as a general practitioner with one of the large corporations that owns many (many) veterinary practices. As with any job there are advantages and disadvantages to it. Here are the ones I’ve found so far:

+

Established training program and process

Pays very well

Reasonable work hours

Standardization of policies and procedures*

-

Standardization of policies and procedures*

Few emergency cases

Not many surgeries

*Standardization can certainly make things easier when you are first learning your way around. It also helps to maintain a minimum level of quality. HOWEVER, once you start to know what you’re doing, you realize some of the things that are “always” done don’t mesh well with your practice philosophy. For example – I wouldn’t run a crap-ton of liver function tests on a patient with an ALT of 120 if given the choice.

As far as the light emergency caseload, that’s okay for now. I need to solidify my general practice skills first. The light surgery caseload worries me a little bit. I don’t count laceration repairs or dental cleanings as surgeries. I count things like spays/neuters, abdominal surgeries, and so forth. So … I’m trying to get lined up with a local rescue organization to help them with spays and neuters. Hopefully that will help keep my skills somewhat sharp!

I suspect that the low emergency and surgery case load is pretty common in all “day practices.”

At any rate, so far it isn’t too bad. In my previous career (information technology) I worked for a huge consumer products company and then for a huge high-tech company, so I’m used to some bureaucracy.

Hello there.

Well, I've been a practicing veterinarian for all of 4 weeks now. That doesn't seem like a lot of time, but I already have a lot to tell you about! I'll try to focus on mainly work-related topics, but have to warn you that I'll also be blogging about my attempts to fit in exercise, socializing, and relaxation into my life too!