Over The Line

I like to think I’m a fairly patient person.  I try to give others the benefit of the doubt.  Everybody has their own set of experiences and insecurities–me too.  And when somebody rings my chimes, I try to look inside and find what hurt, what insecurity is in there, that got my back up when they said or did that.  Usually that defuses my defensive reaction, and I can forgive and forget and make the interaction a productive one.

So it is with more than a little frustration that I have finally reached my breaking point with someone who has been very helpful, yet in equal measure annoying: Atina’s veterinary resident, the one who has been shepherding us through the grueling process of finding out what is wrong with Atina.

It started with her insisting on calling herself Doctor, while calling me by my first name.  Maybe there is a different protocol in veterinary medicine, but in human medicine, to call a senior physician by her first name without being invited to do so, let alone insisting that she, a young doctor still in training, should be called Doctor rather than by her OWN first name, is not only rude, but a major insult.

I let that slide for a few weeks, then had a joking conversation with her about it that either made her blush, or perhaps flush with anger, I don’t know.  It didn’t seem to “take,” in any case, so I guess there’s something about it that I don’t get.

After hanging around Colorado for weeks spending money on campgrounds, I had to start East.  I have stuff I have to get done before I head back to the Southwest for the winter.  I waited five days after Atina’s surgery, to make sure she was OK and that her surgical wound was stable enough to travel, and then I began making my way slowly across Kansas, what a drag.

In the meantime biopsy results are slowly rolling in, and Dr. Vet is being kind enough to forward the reports to me.  Today came a preliminary pathology report, complete with photos of the microscopic sections.  Terrible.  Really terrible.  The results, I mean.  The quality of the pathology studies is excellent.  It shows the mostly non-functioning elements of Atina’s kidneys all too well.

In my thank-you email, I mentioned that because of the storms and flooding on the East Coast, I would likely be delayed past the 14 day timeframe for taking Atina’s stitches out, and if so, I would just remove them myself.  Her reply: she would rather have a veterinarian remove them.

I wanted to blow my stack!  Here is a very junior clinician, who knows that I have many years of practice under my belt, almost all of them in the emergency department, telling me that I should not remove my dog’s stitches.  I’m sure she means well.  Maybe she is concerned that I might get bitten, doing it myself without a tech.  Who knows.

It rang my chimes.

In addition to six months of surgical training in a veterans’ hospital, where they were so short handed that I was first assistant, I did four excruciating months of facial plastics.  Excruciating, because my attending was a total asshole who sexually harassed me, at a time in history when such practices were routine and not reportable.

But the training came in handy when I worked in rural ERa where the nearest plastic surgeon might be 50 miles away, so rather than send somebody off in the middle of the night, I had the skills to repair the delicate layers over an eyelid, or fix a busted lip, reimplant a torn out tooth, pick iron filings out of a cornea using a microscope….

And also castrate my goats, fix plugged udders, sew up my horses when they ran into fence posts, perform reconstructive surgery on my Corgi when she picked a fight with my German Shepherd over ownership of a stick and got her throat badly torn (duct tape makes a fine muzzle in a pinch.  Always have some duct tape around). Of course it happened on a Sunday, and I couldn’t get a vet.  Even the large animal mobile vet wouldn’t come.  He knew me, and suggested I take care of it myself. 😠 My son, who was 14 at the time, held the thrashing Corgi down while I irrigated the wound, identified the tissue layers, and made a decent job of it despite the moving target. 

So of course I bridled at this junior physician’s opposition to my performance of this very minor procedure.  Even if there were a sign of poor healing of the deep abdominal sutures, that is first of all something very easy to detect, and secondly something that would have to wait until I could see my “home vet.”  Clearly, if it were anything major, like wound dehiscence (the wound not healing at all and instead falling apart), I would seek out an emergency veterinary hospital.

So now I’m writing this, as a way to lick my wounds.  I miss my practice.  I miss my active medical life.  I want to go home to the ER and sew people up.  I don’t want to battle death.  I just want to sew people up and pick hair beads out of ears, noses, vaginas, and any other orifices hair beads can get stuck in.  I want to lance boils and pack them with Betadine gauze.  I want to set broken bones and put dislocated shoulders back in place.

I want to rise from the dead.

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  1. Josh Wrenn

     /  October 3, 2015

    I wonder if the response about rather having the vet do them isn’t purely a legal liability thing. It is amazing how many capable people get told not to do something by a professional who started the work in order to ensure nothing can come back on them.

    • Didn’t think about that…But I don’t see where she would be liable for anything. What a patient/client does on their own can’t be ascribed to the physician. For instance, if you had a snitfit one day and pulled out your line, it would not be attributable to anything whoever put it in did. I’ve seen lots of things prematurely or self-discontinued. The only time I might be liable is if I said, fine, pull your Foley out if you don’t like it! (Ouch)

      • Josh Wrenn

         /  October 3, 2015

        Definitely ouch, but just because they wouldn’t be liable doesn’t mean someone won’t sue. I’v e seen way too many settlements based on avoiding litigation in this sue-happy country. It makes businesses and especially providers of healthcare (animal or human) ultra-paranoid.

        • Ugh. When I was in practice, I chose my malpractice provider based on their percentage of cases settled vs. litigated. Thankfully I have never been sued for malpractice, but I have had jerks who tried to sue me for the most ridiculous things because they knew I’m a doctor, and everybody knows “doctor= rich,” right? Like when one of my distant neighbors let their damn dog run loose and it got hit by a car in the general vicinity of my property. The car that hit the dog ran into my mailbox. The two of them were related, and they both sued me! I told my attorney and he almost died laughing (his wife would have sued me had he died, whew!) and sent the parties a letter explaining what happens to people who make frivolous lawsuits. The End. But now I’m being sued because last time I went abroad, someone stole my car and crashed it into four other cars before running into a police car. It matters not to these scoundrels that I was out of the country at the time and the car was stolen. Sheesh.

  2. I hear you. Frustrating when someone doesn’t show proper and well-earned respect. What if you were “retired” rather than “disabled”? Unfortunately, many do not respect disabled or mature adults for their wisdom, their knowledge and their skills. Foolish waste. Even if we are not up to full-time work, our knowledge is still valuable, our minds, our spirits, our skills. We are NOT disposable humans. We retain our value, perhaps are even more valuable, for we are not arrogant as that young veterinary resident was.

    • Thank you, thank you, thank you. You have helped me, by validating my worth as a professional.

      • I know exactly how you feel. Luckily, I have the ear of a few folks at my local NAMI who respect my expertise as both a mental health professional (even though I no longer practice) and as one with lived experience.

  3. Howdy,
    I understand the desire/need to rise from the dead. I “retired” from my veterinary practice 5 years ago b/c of my MH issues and coming to believe I couldn’t continue to practice safely. Sadly, last night my sister and BIL’s 4 y.o. Great Dane was dx’d with DCM and I actually felt useful and competent as I explained the ER visit notes to my BIL and listened to him express his fears and feelings. I didn’t think I could do this anymore. Felt pretty good. A short but incredibly satisfying rise from the grave.
    Also, sorry about the arrogant asshole with whom you’ve been dealing. She has a lot to learn. Doc

    • Aha. Now I know what kind of doc you are! It feels miserable, doesn’t it, to be sidelined from the profession you love, and to feel….Well, you know. Glad you got a chance to use your expertise! What’s DCM? I’ve noticed that the veterinary terms for illness, labs, etc, are sometimes different from what human docs call things. On the subject of the arrogant asshole, I did ask her whether she had ever done any community based practice, was she planning to, or (horror) was she planning to stay in academia (and continue to be arrogant)? She will in fact be going into practice, which ought to teach her a thing or two about humility, hopefully).

      My girl, in the meantime, collapsed twice today while on walks/chasing her ball. But as soon as she recovers, she’s back to her Malligator self, campaigning like hell to go at it again! She’s getting very weak in her hindquarters, and starting to itch. I’m sure she’s uremic as hell. I’ve decided I’m going to let the pup be a pup, and if she dies flying after a ball, she’ll die happy. She’s going to die anyway, so why should she be miserable in the meantime?

  4. I once called my dentist by her first name you would of thought I had lifted her lab coat and slapped her
    Take the God dam stitches out
    And send them to her I the mail

    • Love you, Sheldon…as it turns out, Atina the Malligator is taking them it herself, and doing a better job of it than I probably would. I couldn’t help but notice that the stitches look like a cross-stitch sampler…a few running stitches, a number of simple interrupted sutures, maybe a mattress stitch or two…looks like the vet students were having a suturing lesson. I am more offended at that than I am at the arrogant asshole. You would think they would be more respectful than to use my dog (or any creature) as a playground.

      • I went to a Dr that used to send in the students before he would come in
        Use to drive me crazy
        As always Sheldon

        • When I was a student, I used to always ask if it was OK that I came in. Very occasionally a patient declined, but most of them were happy to see me since I had asked. And I never, EVER called a patient by their first name, unless they asked me to. I am offended by the current practice of calling patients by their first name without asking them how they prefer to be addressed. I always address my elders by their titles, as I was taught to do. I think part of the decadence of today’s society is that children are not taught to respect their elders, so they think they can run over anybody and everybody.

  5. hey there, I would crack that whip on the young clinician’s head! Who the hell does she think she is?? She is being disrespectful to you. You obviously know what the hell you are doing or you wouldn’t have suggested it. I hope you kick that girl’s ass (if you are able, if not you can borrow my good foot!!)

    • Good deal, between us we’ll have a pair! Not necessarily the left and right, maybe two left or two right, but enough to kick ass with 😆. Thanks for your support! You are, unfortunately, an expert at dealing with doctors of all stripes, and I think between the unrelenting anxiety that starts with pre-med and doesn’t ever stop, and the constant bullying within the profession, and the constant drive to be better than everyone else, either drives medical types over the edge (literally), or turns them into callous assholes who should be sweeping streets so they can develop a couple drops of humility in their blood. Us kind and sensitive types get steam-rollered out of the biz, which is frankly a shame because we are who people need. At least that’s what my former patients said, when I got steam-rollered out of the biz. The young chickie in question…I think she had some big lessons coming her way, out there in the big world. People don’t like their vets to treat them like they’re stupid. Thanks for your support! I really appreciate you.

  6. Sorry, DCM is dilated cardiomyopathy which he likely inherited the predisposition for from his mother who died young from cardiac disease.
    I just got off the phone with my BIL, who is sobbing. They took him to a cardiologist this afternoon who found he is now in a. fib. , with a heart rate of 230, and dyspneic. So, they/ve made the decision to put him down tonight. They had planned to let him run the farm, which he loves and had hoped he might just drop dead – doing something fun and oblivious to the future.
    Let Atina die happy. It’s a gift. Doc

    • Oh no, I’m so sorry about the big doggie…it’s awful to have to go down that sad road. Atina is really unhappy today because I just can’t deal with the idea of having to deal with her getting into uremic crisis and being in Northern Kansas, where I would have to either drag my dying dog into my van somehow, or deal with the park rangers and resultant panic on their part…so I’m keeping her fairly quiet for now. I’d really like to get to North Carolina where I can see my own vet, who is a really great guy, and put our heads together. In the meantime is at least like to get somewhere more civilized so that if she dies I’ll have a better chance of getting help. It’s weird to have to make plans based on what to do with a sooner or later dead body, but it’s a fact of life and I want to minimize the collateral damage to myself. I’ve come to terms with the fact that she’s terminally ill, so now I have to take the “when and how” into consideration. And on top of all that, she’s still a puppy who needs to play….


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