On the computer.

Appointment notes: Old cat, losing weight, diarrhoea. AGON PLEASE

There are some moments that that just make your day. Because I only work in the general practice one to two days a week I don't have very many regular clients, so even after 6 months of this it still makes me happy when I see people request to see me specifically.

I am learning that there are some topics that just shouldn't be brought up in consults:

Me: Both of your dogs need to be vaccinated to go into kennels, so I'll vaccinate this dog now and if you can bring your other dog in in the next few days there'll be enough time for the vaccine to work.
Owner: Is it alright if I come in next week? We're really busy at them moment, my wife and I are both running in the election this weekend and our schedules are just crazy.
Me: Oh that's ok, I understand, my [family member] ran in the last state election.
Owner:  Oh really, how did they do?
Me: Pretty well.
Owner: What party were they running for?
Me: [name of rather left wing political party], Which party are you running for?
Owner: [name of extremely right wing political party]

A vaguely uncomfortable quiet descends momentarily, the dog fidgets.

Me (smiling a bit too hard): Oh, right, good on you. Right, well I'll just go and get the vaccine he'll have his jab and then we'll be done.

Lump on a dog’s foot, a saga of questions
(somewhat paraphrased from a series of conversations)

Me: When did you notice the lump?
Owner: Well my friend was over yesterday and said “What’s with the lump?”
Brain: Crap what the hell is this soft subcutaneous lump? It could be anything – abscess, haematoma (bruise), lipoma (a fatty lump), mast cell tumour, lymphoma, histocytoma, haemangiosarcoma etc etc etc.
Me: We should take an aspirate and have a look at it under the microscope, is that ok?

Brain (whist looking at the smear): Crap crap crap, all I can see is blood! Are those interesting looking lymphocyte type cells just from the blood that’s contaminating my smear or is this lymphoma?
Me (to owner): I think we should send this to the pathologist, are you happy with that?

Pathologist: Round cell tumour, likely lymphoma.
Brain: Crap! What the hell do I do next?

Me (to owner): Its bad, it looks like lymphoma.
Owner: What's lymphoma?
Me: Its a cancer made of white blood cells. Would you like a referral to a medicine specialist?
Owner: No I have had a bad experience, I don't trust specialists. What can you do?

Me (to specialist): There’s a lymphoma on this dog’s foot, what do I do next?
Medicine specialist: Can you refer it to me?
Me: No, the owner doesn’t want a referral, what do I do next?
Medicine specialist: Can you get a bigger sample from the lump and one from the lymph node?

Me (to owner): Can we spend lots of money to give your dog an anaesthetic and take a sample from the lump? Btw if the lymphoma has spread your dog will probably need chemotherapy, are you willing to do that?
Owner: Can’t we just cut the lump off? How long will she live? Will she get really sick with the chemo? How long will the chemo buy us? If we’re gonna knock her out to take the sample why can’t we just cut the lump off?

Me (to specialist): Can’t we just cut the lump off? How long will she live? Will she get really sick with the chemo? How long will the chemo buy us? If we’re gonna knock her out to take the sample why can’t we just cut the lump off?
Medicine specialist: If you don’t get the whole lump the first time/the tumour has spread you’ll need to do further surgery/chemo anyway, plus it will probably be a complicated surgery. No idea until we know more about the lump. Less sick than humans get. No idea until we know more about the lump. See first answer. Can you refer it to me?
Me: No

Me (to owner): See above
Owner: Ok, we’ll take the sample, what do we do then?
Me: Probably spend more money to do x-rays and an ultrasound to see if the lymphoma has spread anywhere else. Then we may be able to cut the lump off or we may need to do chemo.
Owner: I don’t really want to do chemo, can we just cut the lump off? How long will she have if we don’t?
Me: Don’t know until we know more about the lump.

The saga is ongoing....

Today I spoke to the owner of a dog that I castrated yesterday, just to check that the dog was going well. The owner told me that he won't get his other dog castrated because it looked strange and he hadn't realised what a major operation it was.

Castration is a very minor procedure, one of the most basic that vets perform. One cut. Clamp. Ligate. Stitch up. My incision was 3cm long, I used only internal sutures and the scrotum was left intact. Oh and I just prevented unwanted puppies, testicular tumours, perianal adenomas, prostatic hyperplasia and undesirable behaviours just to mention a few minor details.

Seriously mate, GET OVER IT!!!!

Today one of the new nurses in my hospital had a revelation: I am one person!
Yes for the past 4 weeks that she's been working with me she believed that there were two really similar looking people in the clinic: Dr Agon in the general practice (where I do 1-2 shifts a week), and the pig lady who does research.
Which one is my superhero alter ego? You work it out.
I need a cape.

I had a day off work today. Because I'm sick. With the cold that everyone at work has given me. Only I'm a casual so I won't get paid. FML

Anaesthetising pigs is an interesting skill that I like to think I'm beginning to master.
First you pre-med the piggy with Ketamine and Xylazine in a syringe with a needle on the end of a extension set. You jab them in the muscle of the neck, the trick is to jab them on the side that's facing away from you so that when the pig jumps and tries to get away from the needle it actually moves closer to you. If they do run away then the extension set gives you a little leeway before you have to start chasing them.

Once the premed has kicked in and the piggle is recumbent, place a catheter into an ear vein (place it as peripherally as possible even though they look bigger proximally they are really wiggly, peripherally they lie in a cartilage groove and are much less mobile). Add an injection port and tape to the ear with brown tape and using a roll of elastoplast om in the inner side of the ear to stabilise it.

Give a bolus of Thio, and wait 30 secs before moving your piggy-wiggy to surgery.
Intubation requires a stylet in your ET tube, a reeeally long straight laryngoscope blade, an assistant to hold the mouth open and lignocaine spray (pigs laryngospasm as badly as cats do)
You will probably need to add another bolus of Thio at this point.
The pig has a really long soft palate, you will have to flick it off the epiglottis with your laryingoscope or ETT before you can see the arytenoids. Iggle-piggles also have substantial laryngeal saccules, if your tube goes into them it will go nowhere and twisting the tube will just move the whole larynx. Aim you tube ventrally and twist it through 90 degrees as you advance it. Tie in place as you would for a dog. Place on Iso and O2.

Ta da! Your pigwidgeon is now ready for surgerfying.

To all those aspiring young vets out there, there is one fact that you must be aware of before you plunge yourself into this industry.

Being a vet is not about animals; it is about people.

Animals are the easy bit: they have a problem, you work out what it is (or you don’t), then you either fix it or you don’t. The people are what make this job the joy and the horror that it is.

People buy animals not realising how much they cost to maintain even at the most basic level.
People give you gifts for putting a beloved pet to sleep.
People breed animals for a certain look not realising how badly this affects their health and continue to breed from them even when their vets have proven they have a serious health problem.
People compliment you on how you handle their rowdy pet and brighten up your day.
People give their cat paracetamol (acetaminophen) because it’s a bit off colour and the owner thinks it might have a headache, only to have the animal die of paracetamol toxicity.
People spend thousands of dollars to save their pets and consider their vets heroes.
People complain about how much vets charge for the emergency caesarean when they wouldn’t spend the couple of hundred dollars to get their dog spayed.
People are your colleagues who don’t mind being yanked out of their own consults to answer your stupid questions.
People don’t see the many extra hours you spend reading up on their animal’s problem to get the treatment right only to refuse treatment in favour of a cheaper option (or none at all).
People are your family to whom you can’t talk about your work because it grosses them out.
People insult you and walk out of your consult room and out of you clinic because the vet they wanted to see has left the practice.
People are your friends from uni, who are there on the end of the phone, who’ll talk to you when you’ve had an awful day, and make you laugh and help you carry on to fight another day.

Being a vet is not what I do, it’s what I am. I knew that from a very young age. My mum recently told me that at the age of three, when I found out that there was a type of doctor that looked after animals, I decided that was what I was going to be. Twenty years on and I achieved that dream.

Crap. What do I do now?

When I first started my vet degree I was convinced I was going to be a horse vet, 2 lectures on horses later and I’d pretty much decided against that. After that I fell in love with wildlife work, until I discovered how many diseases you could catch from wildlife! And my personal paranoia about sickness kicked in and cut that dream short. Then I started working as a nurse in an emergency centre and discovered a passion for emergency work, its speed and its variety. I also discovered the pure joy that was surgery, using nothing but my hands and my wits to fix a problem.

So where to from here?

Do I go out into general practice use the gruelling reality of day-to-day practice to hone the skills imparted by university? Do I leap into an internship and start down the intensive path to specialisation? Do I try my hand at doing emergency work straight from uni in the ultimate baptism of fire?

With so many choices available I did the logical thing, paralysed, I did absolutely nothing.

And, just by chance, a job fell into my lap. A job doing incredible research, working with sheep and pigs and dogs. A job I hadn’t even thought possible as a new grad let alone considered. A job a million miles from a tiny girl's dream of playing doctor to puppies.

Isn’t life odd?