The “Practice” of Medicine

Want to be rich and famous? Don’t become a veterinarian. Want to have a career where you can wear designer clothes that stay pressed and clean all day? Don’t become a veterinarian. Want to eat a big fat slice of humble pie on a regular basis? THIS IS THE CAREER FOR YOU!!

Seriously…the veterinary profession tends to keep you humble. You’ll make a tricky diagnosis and start strutting around like you are the next Dr. House one day, and then miss a case of ear mites the next. You’ll be a kick ass surgeon and rework a cat’s intestinal tract on Monday, and then on Wednesday you’ll puncture a bladder while performing a routine spay. One week you will be the golden child, the one that clients absolutely love and adore, and the next week you’ll be getting nastygrams, or letters from the Better Business Bureau.

Make no mistake…this career will humble you. When I graduated from vet school, I was on top of the world. I was going to be the best veterinarian ever…clients would adore me, animals would calm in my magnificent presence. They would write books one day about my awesomeness.

(In reality, I was fairly terrified my first year out and oftentimes had no idea what I was doing. Of course, I couldn’t let clients or my technicians see that, so I learned to fake it pretty well. I was sort of like the little weeny Chihuahua that barks really loud at a passing Rottweiler…I sounded tough but often felt like running away with my tail between my legs)

A few months out of school, a 5 month old pit bull presented to the clinic with a two day history of vomiting and not wanting to eat. It did not have diarrhea. Those of you that are experienced vets probably know already what the diagnosis is. I had no clue.

I did take a history and performed a physical exam. The owner assured me that the dog was “totally vaccinated.” The dog was dehydrated, lethargic and actually vomited during the exam. I was certain it was a foreign body or some kind of toxicity. I recommended taking x-rays of the abdomen.

As I was confidently walking the dog back to the x-ray room, one of my technicians asked me why I wasn’t testing the dog for Parvovirus. I glared at her a bit, puffed myself up and told her that it couldn’t possibly be parvo, because the dog didn’t have diarrhea! DUH. Also, the owner said it was fully vaccinated. DOUBLE DUH. The technician stated that a lot of times Parvo dogs came in initially vomiting. I rolled my eyes and told her to get the x-rays.

As they were x-raying the dog, it puked a few more times. As they were developing the x-rays it sprayed bloody diarrhea over every surface of the x-ray room. I would later find some on the ceiling.

Well, as it turns out the x-rays were normal other than showing very angry looking small intestines. I muttered under my breath that there was NO WAY it was Parvo, but reluctantly allowed the technician to run a Parvo test. Low and behold, it most definitely was Parvo. I had just paraded a dog with a VERY contagious disease all around the hospital. The dog had sprayed Parvo infested diarrhea all over the imaging room.

I learned from that episode to A) Never trust an owner when they say their dog is “vaccinated.” B) Parvo dogs can present initially with just vomiting. C) Listen to your technicians.

Another time my head got pretty swollen because a client actually requested me to change her dog’s splint. It was a little Chihuahua with a broken radius that my boss had been treating by splinting. The splints he put on kept falling off, which annoyed the client. I happened to put on a splint that stayed, and she was singing my praises in the lobby.

I took the dog to the back, hemmed and hawed to my staff about my vastly superior bandaging technique, and even managed to put two little red hearts made out of vet wrap on the splint. The client loved it! I was awesome! I walked on water! As she was bowing down to my immense greatness the Chihuahua shook its leg a little bit and the splint came flying off. Oops. The client didn’t really care so much about the vet wrap hearts at that point.

I have tried to spay a neutered male cat. I’ve accidentally cut into a bladder during a spay. I’ve raved to clients about how AWESOME they are doing with weight loss on their fat cat only to find out that the cat is a diabetic. I once did a physical exam on a newly adopted Boxer, and told the owners it was in great health and there were no abnormalities. They called the next day, pretty upset because overnight their “normal” dog gave birth to 12 puppies.

On a more somber note, I’ve made mistakes that have resulted in the death of my patients. A little Labrador puppy was bitten pretty badly by a neighbor dog. I saw some deep puncture wounds, but not much else. I cleaned her wounds and put her on antibiotics. I missed the hole that had been torn in her intestines, and she died a few days later of a raging abdominal infection. I misdiagnosed a cat with asthma, when it had heart failure. That night when the owner attempted to give him medication for the asthma, the cat died of heart failure, most likely secondary to the stress of medication. I missed that a dog I put on Rimadyl was also on steroids, and ended up causing the dog to suffer a perforated stomach ulcer.

I even had a cat die after I neutered it. I still to this day am not sure what happened, but I know that he was very little, and I was “fairly” sure I was cutting a testicle. Whatever it was that I cut wouldn’t stop bleeding and he died a few days later. A cat neuter is considered to be one of the simplest surgeries we do as veterinarians.

Now, I know you are all thinking that after knowing all this there is no way in heck you would use me as a veterinarian. Here’s the thing though….we all have messed up. We have all missed diagnoses, screwed up a surgery, given a wrong medication. My grandma always says that is why they call it the “Practice” of medicine.

As horrible as some of the mistakes I’ve made have been, I have learned from every single one. Today, I would not miss that Parvo diagnosis. I treat dog bite wounds very seriously and always look for deeper injuries. I am careful to try and differentiate a cat with asthma and a cat with heart disease. Every time I neuter a cat I think of my neuter that went horribly wrong, and I remind myself to not treat it lightly even though it is such a straight forward surgery.

I also don’t let myself get too cocky or confident. I’ll smile when I make a tricky diagnosis or do a tough surgery, but I don’t strut. I know that probably within a day or so I’m going to do something that will knock me back down to earth. When I hear of mistakes other veterinarians have made, instead of feeling superior, I nod with sympathy and think back on the mess ups I have had.

Phyllis Theroux, in Night Lights states that “Mistakes are the usual bridge between inexperience and wisdom.” If you are a new veterinarian or technician, give up on the idea that you are going to be perfect. You will make mistakes. You will harm a patient because of those mistakes. Learn from your mistakes. Don’t blame others, or incessantly beat up on yourself. Take a deep breath, file it away in your memory, and keep carrying on.

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About hteyler

I decided in 8th grade that I wanted to be a veterinarian. I never deviated from that goal, and after a ton of studying and hard work I graduated from Colorado State University with my Doctorate of Veterinary Medicine in 2004. I spent the first few years out of vet school in the southern California desert. After a few years I missed the mountains, so I took a job at a small animal practice in Park City, Utah. Somehow, in the middle of all of that the teaching bug bit me. I am now the Resident Veterinarian at Broadview University, West Jordan. Also, I have four cats, Pete, Sally, Tommy and Roger. If I told you much more, you would decide I am a hopeless nerd. For example, I am obsessed with the TV shows LOST and Supernatural.

Posted on August 7, 2012, in Uncategorized. Bookmark the permalink. 7 Comments.

  1. I just wanted to say “thank you” for this particular post. Just recently gave a steroid injection to a cat that 2 days later ended up in the emergency clinic with pulmonary edema. Owners rightfully furious I didn’t warn them this was a potential outcome. Feel horribly guilty and awful for the cat. It is nice to read about others mistakes and know they survived and moved on from it. Lesson learned.

  2. Anyone who says they haven’t joined the “Spayed a Male Cat Club” is lying! They know in their heart of hearts that they did it too. If you’ve been in practice long enough, it will happen.

  3. Yes, we all have those times that haunt us, but we’ve learned from them. We are human beings, which is basically the definition of “we’ll make a mistake”. Not dividing a pet’s pounds by 2.2 for calculating an ivermectin dose has made me particularly paranoid about checking and rechecking and rechecking my numbers. I’d like to share this TEDtalk that is relevant to any medical profession and should be shown to all students: http://www.ted.com/talks/brian_goldman_doctors_make_mistakes_can_we_talk_about_that.html

  4. I found your blog via a friends share on facebook and wanted to say Thank You! I graduated from LSUSVM in 2005 and went into small animal practice 70+ hours a week for a couple of years. I moved with my tenure chasing academic of a husband to SoCal, had baby #1 and cut back to 30hrs a week. A few years later we moved to Florida again for his job and found out #2 was on the way. I’ve been “at home” ever since. Well, #2 is 3yrs old now and it is time for me to find my way back to work, and I am terrified! Like knot in my stomach fear… I have a vague memory of clients always really loving me. I seem to think I was a good doc because my bosses always seemed to be happy with my work. I can barely remember the few times I did something really awesome. And now that I think about it I might just have been really good at my job. Mostly I remember that one sweet Shepard mix that died under anesthesia after the owner refused labs…I had a bad gut feeling from the start and it was just a dental. One time I miscalculated acepromazine and put a full grown lab in a trance for 10 hours. I can’t remember what I did but I remember an owner yelled at me and was totally justified because i did something really stupid. I cant get that little persian that the owners found dead under the bed the day after I assured them that the vaccines were “totally safe” out of my head, or yeah I opened up a male cat too. Thanks for sharing and giving me a little more confidence. I loved “the practice of medicine.” Glad to know I’m not alone. Cheers!

    • Hi pilesoflaundry. This has nothing to do with the post, but I’m also a stay-at-home-mom/vet-on-hiatus married to a tenure track college prof. I stopped working altogether with baby #1 almost 4 years ago, mostly to be home with him, but also due to emotional burn out. I just had baby #2 (3 weeks ago!) but, I will probably start looking for a part time position in 6 months – mainly because the hubby thinks if I don’t go back to work soon, I won’t go back! I am definitely more than a little nervous. We should commiserate! If you ever read this, message me back…

  5. Wow, I’m impressed at your candor and your willingness to bare your soul as it were. I am a mixed animal veterinarian and I could also provide a long list of all my mistakes, many of which resulted in the untimely demise of a patient. There is definitely a reason it is called veterinary ‘practice’ and not veterinary ‘perfect’. Thanks for your blog!

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