Logistics Behind Ambulatory Work, Part II: Drive Time

I receive quite a few questions from ride alongs, job shadows, students and clients about the ambulatory component of work as a mobile equine vet. I decided to share some of my experiences and insight by answering some of the most common questions I get. In Part I, I discussed some of the logistics behind scheduling, navigating and billing for our practice.

The next series of questions I am frequently asked include:

  • How much time do you spend in the car on average per day?
  • What is the longest you’ve ever driven to one place?
  • What do you do in the car all day?

 

Drive Time

Google Map’s timeline is an invaluable resource for tracking how much time we spending getting from point A to point B, tracking mileage, tracking the time spent at each farm call and overall time spent driving per day. All this data is arranged in a calendar mode, meaning I can pick any day of the month and retrace my route.
The season and whether or not I am on call are large factors in the amount of time I spend in the car. I went back and reviewed my timelines from different months to get an idea of variation between seasons.

Our slow season is November-March, so I chose to review the month of January. For the month of January, drive time was 2-3 hours per day with 2-3 farm calls (1-2 hours were spent at each farm call). My on-call days with emergencies increased the average number of hours to 4, with 1-2 farm calls per day. The average appointment time for these emergencies was 2-3 hours.

From March-June, business starts to amp up. For May, drive time per day averaged 4-5 hours with an average of 4 farm calls a day. On days with emergencies, drive time was 5 hours with 2-3 farm calls per day.

Our peak busy season is from the end of June to the beginning of September. When I reviewed my timeline data for July and August, my jaw dropped. I knew I spent a lot of time on the road…but was still shocked to find that the average amount of time I spent in the truck was 8 hours per day with 4-6 farm calls per day.

And the longest we ever spent driving in one day? 10 hours!! This was for a day with 4 farm calls appointments and 3 emergencies. And the longest drive I’ve made in one direction was 2.5 hours, from the northern part of the Realm to the western part of our Realm with closure of a major highway due to an accident.


Making the Most of It

When not in conversation or on the phone with clients, the first thing I do during the drive between barns is complete my medical records and invoices. This is, by far, the biggest advantage to having my assistant drive. At my previous job, when I did not have an assistant, I would have to do invoicing and notes at the end of the day…often times adding another 2-4 hours to my work day. Not only was this exhausting, but increased my errors on invoices and reduced the quality of my medical records.

Once medical records and invoices are done, other work-related tasks I do are review lab results, go over my follow-up list, and review the appointments for the next day. When that is all said and done, I move on to entertainment. I have a wide variety of music tastes, but spend enough time in the car and all types of music wear on you after awhile.

So, I discovered podcasts…a wide variety of podcasts that range from veterinary education, to psychology, crime, current events, controversial topics, history and so on. Some of my favorites include:

Favorite Podcasts from Pocketcast
Advertisements

Logistics behind Ambulatory Work

Occasionally, we have ride-alongs or people doing job shadows, usually students ranging from high school to vet school. For those considering a career in veterinary medicine or future ambulatory vets, it is an interactive, uncensored day-in-the-life experience. The types of questions I did not really expect to get were regarding commuting and driving. The questions I get asked most often include:

  • How big of an area do you serve? What are the logistics behind scheduling appointments? Who determines the route? How do you know how much to charge for a farm call?
  • How much time do you spend in the car on average per day? What is the longest you’ve ever driven to one place? What do you do in the car all day?
  • Does getting car sick mean you can’t be an ambulatory vet?
  • Does the truck ever break down? Have you ever gotten in an accident with the work truck?

I’ve received these questions often enough that I decided to write a couple posts about this side of the profession from my personal experience.


The Realm

Our service area (which I refer to as the realm) is vast, one of the largest I’ve seen. From where our office is located, we service up to an hour and a half in every direction…meaning our call radius is 1.5 hours, not factoring in traffic. The realm ends up being a large part of the western side of our state. While the majority of our work is North, an emergency an hour South of our office could mean a 2.5 hour drive from one end of our range to the other. Most practices I’ve spent time with service a 40 minute radius around their hub.

As for navigating the realm? I have to give a shout out to navigation apps. All of this would be a lot more difficult without today’s smart phones, GPS etc. I consider myself very fortunate to practice in a time when this technology is easily available. Not afraid to admit that I cannot imagine the farm call experience before Google maps existed. For the vast majority of our navigation, we use Google maps and Waze, which do a great job 95% of the time.


Scheduling

Luckily, our front office staff are all locals with an excellent knowledge of the cities/towns and road system. Equally important is knowledge about traffic. The commute to a particular barn in the morning could be well over an hour, while the same route could take 30 minutes if its around lunch time.

Efficiency requires concise, well-planned routes, the front desk carries the heavy burden of scheduling. And they are phenomenal at avoiding the big scheduling mistakes, which off the time of my head are:

  • Return trips (same barn more than once in a day)
  • Same stops (different doctors to the same barn in a day)
  • To-and-fro (alternating near and far locations like North  South  North  South …vs. starting north and working south throughout the day)
  • Localizing (keeping all farms in a particular direction, vs having calls at complete opposite ends of the service radius)

I have full respect and appreciation for the skills of the front desk staff, because I dabbled in scheduling at my previous job and found it to be a pain-staking, hair-pulling mess.


The Financial Side

Minimizing drive time is essential, as our farm call fees (ranging from $80-140) over times barely cover the overhead and wages one way…not to mention if the next call is equally far at the other end of our range. Often times, the company actually loses money as the basic, rough example below shows:

Farm call 40 miles from office, 1 hour drive time

  • Farm call fee charged to client: $100
  • Gas: $10
  • Vehicle wear and tear, mileage, licensing, insurance: $25
  • Assistant’s time (company cost): $25
  • Doctor’s time (company cost): $60
  • Total cost to company for farm call (one direction): $120

Not a precise or perfect example, but easy to see why scheduling and routes are so important. And after all the effort is made into tactfully planning an efficient day, there comes an emergency call that changes it all…and even if the call is at the other side of the realm, traveling in peak traffic hours, those facts don’t register because the focus shifts to getting there safely and as soon as possible, so that we can do what we joined this profession to do- care for our equine patients and the clients attached to them.

Newest Vet on the Totem Pole

Whenever I become frustrated while learning and improving upon particular skillsets or techniques, especially when my progress isn’t meeting my expectations, I think of a specific phrase to provide perspective. Every vet was a new vet at some point. The only way to get 10 years of experience, is to spend the 10 years gaining experience. It goes without saying that no vet was born with a doctorate straight out of the woom. Any expert, instructor, teacher, trainer, mentor etc…was at some point, a beginner themselves.
While sometimes I feel TOO aware of where my inherient new grad weaknesses are, itwwould not be safe for me to assume my boss and more seasoned colleagues are just as aware. There have been times when I have had appointments put on my scheudle that I had absolutely no or an insecure amount) aof experience performing or even interpretting. For this reason, the seasoned and invested colleagues of the practice are worth their weight in gold.
I’ve been an associate at my first “serious” multi-doctor practice for a little under a year. Soon, my one year employment contract will be over and I am already looking ahead to negotiating the contract for the second year. To be hoenst, I was in sucha pinch to find a new job after leaving my first private practice job, I did absolutely no contract negotating. I will say this is “new vet” lesson #1. Coming in as the new vet does not mean you “Take what you can get” and certainly doesn’t mean that you’ll have to tough it out with a “pay your dues” themed contract. To any “new vet,” my first recommendation is to negoatiate and not just settle for the minimum.

The lessons learned over the past year are countless, but I put together a list of the more prominent lessons, surprises, realizations and adversity I faced in this first year, in the context of a new graduate and new hire. Every practice is different, and maybe some of my list is unique to my practice…but worth sharing regardless
  • Desire to “prove” yourself is natural. But proving your worth does not mean you have an inherent labor or favor debt to other associates.
  • Case-pushing and dodging. You’ll get the bottom of the barrel for cases and clients. There were clients and patients that other vets refused to see once I was around. Clients that wer rude, inappropriate, didn’t pay their bills, used other vet practices interchangeably and sometimes even notorious patients (mean, dangerous, feral). Whatever cases other doctors wished they did not have on their schedule, would end up on mine.
  • Opposite of case-pushing, is case-nabbing. These tend to be new clients that would contribute to a strong clientel of an already established vet. On multiple occasions I had new clients who were put on my schedule for gastroscopies (or other advanced diagnostics/treatments) but several days later suddenly appeared on a different doctor’s schedule…for no reason, with no discussion.
  • New grad and new vet double wammy. I have lost count of the number of times I arrived at an appointment and the first thing clients commented on was my age. Most commonly something along the lines of “Aren’t you a little young to be a doctor?” or “You must be the assistant. When does the doctor arrive?” There are also the demeaning references based on the gender and age included calling me girl, missy, little lady, youngin, gal, or refusing to address me as doctor.
  • Skepticism. Yeah, you may be absolutely right on your diagnosis and treatment recommendations…but for it to be legit, you’ll need the backing of another associate that you’re doing the right thing
  • The interpersonal dynamics of the practice alone have been difficult. The biggest difficulties have been when staff refuses to show the same amount of respect to the new doctor (especially if they are outgoing, kind and amiable) as they do the senior vets that are hard on staff.
  • Favors. That can become a slippery slope when the staff finds out the new vet will not be so protective of their time and feel too guilty about charging for services. I did a dental for a staff member who had one horse, and I did not charge for my time. Another vet in our practice would’ve charged 300 compared to my 75. Word got around and suddenly I was at the beckoning call of every staff member who owned a horse. This is a great way to fill your schedule and prevent you from getting actual cleints. This is also another way to end up getting called for emergencies for staff animals when you aren’t even on call that night!
  • Establish your professional and personal boundaries. A favor is simply that, and no one is entitled to favors.
  • You’ll do things different. You’ll get called out on it by non-vets. I had an assistant argue with me about passing a NG tube up the wrong nostril. I always pass on the left so I can see the tube go through the esophagus for visual confirmation. Apparently all the other doctors tube on the right. The assistant telling me I was doing it different, and not like all the other vets, seeded an unnecesary amount of anxienty and fear in the client…while also undermining my professional knwoeledge and abilities.
  • Don’t take it personally when you meet a colleague’s client, establish a great rapport, save their horse from a critical emergency….then see months later that they insist on sticking with your colleague for upcoming dentals, vaccines etc. Don’t assume that this is because you did something wrong. Don’t underestimate the bonds between your colleagues and their clients.
  • The learning curve is steep but you don’t have to do it alone.

the Vet’s Assistant

The idea of having a vet assistant in the field was obscene to my first employer. She viewed them as an unnecessary (and even impossible) expense and liability for any solo practitioner. Whether it’s for the similar reasons, most vets in the area do not have assistants. I remember reading an AAEP article back in vet school, which discussed a multitude of reasons and scenarios in which it does pay off for a solo practitioner to hire a field assistant. I remember reading the article, never having seen an equine vet with an assistant, and thinking what a luxury it would be.

Then I hit that job lottery, the place I work now. It’s not that assistants are merely an option, but that taking assistants in encouraged…and there is the obvious list of reasons. There is also the not-so-obvious list of benefits and rewards that come with having a comrade out in the field.


Teamwork Makes the Dream Work

77fe17bc3b9799cb910c887098b0ca37--zebras-giraffes-01.jpeg

DVM 360 has a recent article about this very topic, called Equine vet techs deserve a seat.

Our assistants are wonderful, and with individualized training, their potential is endless. The basic responsibilities in our practice include managing daily truck inventory and restocking, manage truck maintenance/repairs/cleaning, cleaning/maintenance/trouble shooting of all equipment (xrays, ultrasound, endoscope, dental equipment etc), cleaning/organizing/packing up for all appointments, horse handling (some vaccinate and draw blood), processing in-house lab work, uploading all digital imaging/lab results, help manage schedule, driving (allowing plenty o time to SOAP and invoice for the doctor) and so forth. With the help of the assistant, I can do 3 dentals in the time it took me to do one alone. I easily see three times the number of appointments in a day with how our team works.


Unsung Heroes in the Field

But aside from the logistics, there’s the other advantages…company. It’s a lot of hours in a truck most days (2-3 hours of driving usually, sometimes up to 6 for a day with ERs and appointments). You can’t put a dollar amount on good company, especially on long exhausting or stressful days, where you have someone who was with you for every moment of it. It’s both a professional and a personal bond. Comic relief, podcast discussions, small talk, singing along with the radio, reviewing cases we saw that day, an ear to listen, or even just the feeling that you’re not alone taking on the world of equine medicine. Not to mention the safety…unfortunately, not all owners are as skilled at handling their horses as we would hope. There has been many a time (and more often than not) that the situation becomes significantly safer by having the assistant handle the horse with special restrain techniques, or even just positioning for exams/flexions/nerve blocks. I remember coming back from an ER at 3AM, after a full day of work, and rolling down the windows singing at the top of my lungs trying to stay awake on a windy back-country road….I came close to falling asleep at the wheel multiple times, and am very thankful I haven’t had to do that again.

And for everything they do, the things doctors expect, appreciate and need….there is an endless list of all the unseen, unmentioned ways that they support us on a daily basis. Being a veterinarian, you face challenging, humbling, heartbreaking and gut wrenching experiences…and experience equally rewarding, uplifting and inspiring moments. It’s those rewarding experiences that give me the feeling of happiness…and the only thing that makes that happiness even greater, is when it’s shared with a teammate.


Thank you to all the veterinary assistants and technicians who remain unsung heroes in the veterinary field. Whether you’re in the exam room, surgery suite or field, the wonderful aspects of vetmed would not be nearly as wonderful (or even possible) without you!

Unsolved Mystery (Part 2)

Picking up where I left off, the last entry was about an emergency case involving a non-weight bearing lameness and unexpected penetrating wound to the abdomen. Without the financial option for referral, the owner (fictitiously referred to as Karen from here on out) opted for managing the mare (fictious name of Sugar) at home. Our aggressive antibiotic required placement of an intravenous catheter, and intense training session regarding care, maintenance, problem solving and how to use a catheter. I am always nervous when it comes to client managing catheters in the field. Luckily, Karen had previous experience working under a vet in an equine surgical center.

Sugar was started on a 5 day course of intravenous antibiotics (Kpen and gentamicin) and an anti-inflammatory (flunixin). The dime-size penetrating wound was sutured closed. I expeted that the would see evidence of complications (peritonitis, compromised bowel etc) within the first 24 hours, and was pleasantly surprised when Karen informed me Sugar was holding steady. Her appetite and energy level remained consistent, as did her severe lameness on the hind leg. It wasn’t until day 3 that she threw the first fever, a staggering 104.5 F. When the fever was unresponsive to banamine, Karen took to giving alcohol baths. I was anticipating at any moment, the downward spiral would begin…but aside from transient fevers, Sugar was still holding steady at day 5.

On day 5, Karen reported the catheter wouldn’t flush and after confirming it was no longer patent, we pulled it. To continue the antibiotic coverage, Karen was given excede and her fevers had stopped. Haunting still, was the none-weight-bearing lameness that remained unchanged, and was now making me suspect a pelvic or hip injury. With her budget depleted, no additional diagnostcs or treatments were an option…and we began discussing quality of life concerns for the severe lameness. Karen painfully drew a cut-off point for Sugar’s recovery, which was a week. If her hind leg wasn’t showing improvement by the end of the week, she would have to be let go.

I didn’t hear from Karen for a week, and when an appointment popped up on my scheduled, I assumed the worst. Much to my surprise, her lameness had improved by 50%. And after another week, she was 90% sound on the left hind. Sugar never looked back after that…she recovered completely, despite the odds.

Word on the Street

And the mystery of the penetrating injury? It’s all heresay, but on my final visit to see Sugar…a neighbor just happened to swing by.

“It’s been bothering me ever since day 1. I was working in the garden, a quarter mile down the street. And you seen those big concrete pillars? Well, that day I was pulling weeds, and saw this man park his car right next to the pillars. He got out with a big black duffel bag and I remember wondering now what is he doing. At first I thought he was just working on something for the county. But he was in normal clothes, a white t-shirt and jeans. I just kept doing my gardening and it must’ve been an hour. When I looked over, he was laying on his stomach on the top of the pillar, like they always show snipers doing. And I heard my phone ring, so I went to answer it and in the middle of my phone call, there was a gunshot. My husband and I hunt, I know a gun shot when I heard one. I thought he’s poaching! I looked out to see he was still there on his stomach. So I called the police because you can’t be firing into someone’s pasture or at farm land like that. Well, I was terrified and stayed inside…I didn’t want him to know I was in there. When I heard the police knocking and answered the door, I could see over their shoulders that other cops were walking around the pillar but the guy’s car was gone. I think that guy shot the horse!”

Seeing the Signs

This story stuck with me, because a month later, at a farm in the area there had been a couple cows believed to have been shot (they didn’t die, but had wounds similar to Sugar’s. When a dog and goat were shot a months later in the neighboring town, what originally sounded like a far fetched theory…started resonate.

It’s been a couple months now, and I have yet to hear of more animal shootings…but if this really is a person targeting animals, could the target become a human? Unfortunately, the city and state police don’t consider the events related…but it also sounds like there has been little follow-up into what could be considered early indications that we have a fledging psychopath.

the Unexpected Problem #2 (ER case, part 1)

After seeing a couple of routine appointments, we started receiving back-to-back emergencies. Our emergency calls included a colic, a foot abscess, a case of cellulitis and a minor laceration. Around 9pm, right as we parked the work truck in the garage, my work phone rang. On the other end of the line, was a panick stricken owner who thought her horse had fractured its leg after getting kicked by another horse in turn-out. We regrouped, and made the short 25 minute drive to the ER.


The Presenting Complaint and (Most) Obvious Problem

When we arrived, we spotted the mare in the beam of our headlamps. She stood in the pasture, trembling, painful and unable to bear weight on her hind leg. Aside from a <1 inch long laceration through the skin located in front of her hip, there were no real significant findings on my physical exam. I could not palpate a fragment, fracture or instability in the limb. After ruling out a foot abscess, fracture of the distal phalanx, we confirmed no fracture from the stifle down. Our radiograph equipment in the field is not capable of shooting images of the hips or pelvis, and with no ultrasound, ruling out a pelvic fracture wasn’t going to be an option. Leaving her in the pasture, without water or shelter, was not an acceptable option. After giving pain meds and sedation, we inched our way slowly and steadily to the barn.

Discovering the (Less) Obvious, but Equally Serious Problem

In the barn, I turned my attention to the wound over the hip while I next steps for the painful leg. After clipping around the wound, I was both shocked and disturbed to find out the extent of the wound. What looked like a superficial, small tear in the skin, was actually a dime-sized penetrating wound. With a flashlight, I looked into the wound and probed the extent. Beyond layers of muscle, fascia, fat and connective tissue…I found myself looking through a tiny viewing window right into the mare’s abdomen. I saw the glisten of light off what I presumed to be the right dorsal colon.

Bad Gets Worse

A penetrating wound into the abdomen doesn’t carry a favorable prognosis, especially when managed in the field. The client’s financial constraints meant referral for hospitalization was not an option. Abdominocentesis (belly tap), bloodwork, ultrasound, SAA…also not within the financial realm. Dedicated to trying, and wanting to give the mare a chance, the client asked for the most aggressive approach we could take to treating in the field within set limitations.

Antibiotics, anti-inflammatories, suturing the wound and monitoring comprised the mainstay of our treatment protocol. To be honest, I was expecting these efforts to serve mainly as a comfort and reassurance that we had tried something. I’ve seen horses succumb to far less serious ailments with intensive treatments and hospitalization. We placed an IV catheter so we could start a robust course of antibiotics (kpen and gentamicin) and banamine.

Where it gets interesting

By 1am, we had discussed catheter care, administer meds, given extensive instructions on what to watch for…and when we left, the entire ride back was filled discussions on everyone’s thoughts, ideas, speculations …wondering about the source of the lameness as well as the surprising penetrating hole. The hole was clean through the side of the horse, with defined edges and minimal surrounding trauma…almost like it had been made intentionally, by someone blessed with the art of careful dissection. Without knowing the systemic status of the horse, I could hardly sleep with thoughts of the undiagnosed fracture, the possibility of punctured bowel, the chance that whatever punctured her side could be floating around in the abdomen, the imminent danger of sepsis and endotoxemia…this, combined with group speculation as to what caused the wound.

A stick?

A nail?

Fencing?

Tree branch?

What about a bullet? The client asked, explaining that the family dog had sustained a similar injury a year ago when he had been shot with a small-caliber gun (pellet gun or 22?) by a disgruntled neighbor. With so many unknowns, possible complications and serious risks associated with this emergency case… I was not optimistic about the outcome of our next visit, which I expected would in the very, very near future.

Luckiest vet in the world


The hostile work environment, professional sabotage and unethical veterinary practices I faced at my first job as an equine practitioner in private practice made the first 6 months a living hell. After working over 100 hours per week, my boss’s vengeful decision to “punish” me by withholding my paycheck, brought me to the breaking point. Against the advice from my family, and with the support of my friends and colleagues, I quit my first job without a 2 week notice. If having profane names yelled at me wasn’t enough, my boss then told me “I know all the vets in this area. You’re never going to be an equine vet in this state.”  My assertive response was “Not you, or anyone, will ever stop me from being an equine vet.”


2 months later

By October, I was hired as an associate at a multi-doctor equine private practice that not only has a phenomenal reputation and rapport with the equine community, but also has a “work family” atmosphere. Although I knew my previous job was horrendous, I didn’t realize how terrible it was until I started at my new job. Better hours, better pay, respect, benefits (health, retirement), mentors, the opportunity to be my own doctor, strong support staff, emphasis on the highest standard of care, safe/reliable work truck…for the first couple months I felt like it was too good to be true. I was waiting for the facade to come down, but now 6 months into my new job, and this is sincerely, genuinely the wonderful place I work.

 

The only negative/downside? My goal was to spend 3-4 years at my first job before moving to Colorado for a “dream/forever” job…and there is a little part of me that thinks darn, I found my dream job already and it happens to be in the wrong state.

 

And if that’s my only complaint…I may be the luckiest vet in the world.

Facing the Repercussions

To really understand this post in context, you’ll need to understand the backstory. If you haven’t already read the predecessor to this entry, I highly recommend it.

In order to make an employee’s last two weeks a “living hell,” Dr. Cray gave the office staff and myself her decree to engage in work-place warfare. My last post left off at a pivotal moment. I accepted the reality of the work-place situation and the brutal truth about my boss’s nature. Then, I did the thing I should have done months ago. I spoke up. I refuse to make someone’s life a living hell. And from that point on, the work-place is becoming my living a hell.


My Redefined Role and Responsibilities

Everything but a Veterinarian

Unable to hire new employees, the office was severely understaffed. Now, instead of seeing appointments in the afternoons, I was assigned to the front desk as a receptionist. This is when I began to struggle, both personally and professionally. And the troubles didn’t stay at work. With only two other employees, Dr. Cray’s started singling me out. She became uncharacteristically kind to the other two office personell, bringing them gifts each morning and asking about their weekend. When she turned to face me, she snap at me to go clean her instrument tray from the ER last night or go count the vaccines in her truck. Everything became a test or barrage of rapid-firing questions (to which some of the questions were about patients I never saw, prescriptions I was never involved in, or billing accounts that were from 5 years ago). She seemed content if I did not know an answer, and became vicious when I did. She took to devaluing me in front of clients and other employees.

wp-image--1971914626

Within a couple weeks, she allowed me to see appointments only 1 day a week. When clients requested appointments with me, she told the office to tell them I wasn’t available…little by little, I watched the only benefit to my job dissipate. Veterinary experience, the only thing worth staying for, was slowly replaced by my new duties which included:

  • Restocking supplies, tracking orders,
  • Create and maintain inventory system
  • Truck inventory, maintenance
  • Manage all social media accounts
  • IT for all office equipment (phones, computer, scanners, fax, internet)
  • Invoicing
  • Equipment maintenance
  • Barn tasks (feeding, stall cleaning, turn-out)
  • Yard upkeep

Veterinarian turned Receptionist turned Detective

All those hours I put in at the front desk paid off. In an attempt to fully analyze the situation, and come up with a plan…I started gathering intel. When the UPS guy saw me up front, he said he wouldn’t bother learning anyone’s name because no one sticks around long enough for it to be worthwhile. Thanks to the UPS guy, I started looking for more information about the previous associates. I remembered she didn’t order me business cards for the first 2 months in case I was going to quit. She said she’d spent too much money on wasted cards. After looking into the business card order history, what I found was startling.

wp-image-1830908632

Over the past 10 years, 9 associates were hired, and of the nine associates not a single one worked for Dr. Cray longer than a month. No surprise there! I also had mixed emotions about what this said about me. Obviously someone with a healthy amount of self respect would not put up with or stay in this type of environment. I don’t like to quit, and I will endure, endure, endure. Although I gave myself credit for getting through the last four months, I also had to change my way of thinking. I’m not here to endure. My goal and aspirations are not to endure life, endure each day. What is the sense in being in the profession I love, if every day I dread and resent going to work? I suffer, my relationships suffer, and it doesn’t do the profession any good.


If someone doesn’t know whats wrong, how can they fix it? I’m a believer in that concept, and I had been silent for too long. If we were going to make this work, we were going to have to make some changes. It was time to sit down and have a chat with Dr. Cray. I worked the meeting into our schedules, and gave her a heads up that there were some items I wanted to discuss with her.

And in 2 days, that’s exactly what we’ll do.

#veterinarian #vet #vetmed #vetlife #equine #horse #equinevet #ambulatory #mobilevet #veterinarypractice #dayinthelife #doctor #profession #equineveterinarian

The Work-Place Honeymoon Stage …is Over

Unlike my usual posts, this one isn’t about a particular case, patient or exclusive veterinary experience. This post falls under the venting category and serves two important purposes.

  1. Venting (everyone needs an outlet)
  2. Documentation of events (just in case)

There have been concerning changes at my work-place over the last couple months, and largely have to do with my boss/practice owner, who I’ll refer to as Dr. Cray. These changes and the current conditions at work are certainly not unique to the veterinary field. Unfortunately, I know situations like these can plague any professional field and work-place. I also know there are far worse working conditions and nightmare bosses out there than what I’ve experienced.

So, if you already know that there is nothing I can say to make it worth your time to read the following gripes, complaints, emotion portrayals and speculations, then I recommend passing on this one. Otherwise, I’m an open venue to opinions, thoughts, shared experiences…please feel free to comment or message me.


When the work-place honeymoon stage is over…

During my interview back in January, Dr. Cray made a great first impression. Out-going, charismatic, enthusiastic, charming and equipped with a great sense of humor. Afterr 20 years working as an ambulatory vet, she still appeared to be very much in love with her job. After the working interview, I remember thinking ‘Wow, I hope someday my clients like me that much.’ The admiration, appreciation and respect that clients had for her was irrefuteable. Some ever professed how much they adored her during the appointments. She was friendly and kind to me, and told me she had been waiting a avery long time to have an associate. She mentioned in passing that the last two associates she hired quit within the first month. Hindsight: Red Flag #1.

Within a month of starting work, I began seeing appointments and we split emergency on call 50/50. She was an endless source of support, encouragement, advice and constantly reassured me that she would never ‘throw me to the wolves.’ The first 6 weeks were the golden weeks, when we could do no wrong, talked endlessly about cases, life, experiences, teamed-up on on a in-patient laceration and fed off of each other’s enthusiasm. Every morning, I was excited to go to work and was oblivious that unbeknownst to me, this Honeymoon Stage would be wrapping up shortly.

During the internship, I was the “ER magnet.” Meaning, if I was on call, everyone could expect at least one emergency. This carried over to my new job once I started taking on-call. My first weekend was jam-packed with ERs, and I had back-to-back overnight ERs. The ERs came in waves, spilling into the weekdays. With at least 3 ER calls a day and a schedule entired booked with apppointments, we had to divide and conquer. At the end of the week, she said “Thank goodness you are here. I would not have been able to it without you.” That is the last kind thing I remember her saying to me.

Around week 8, I started to notice passive aggressive remarks directed at me. I gave them no mind, since you never know what people are going through outside of work. I remained pleasant, out-going and supportive. Then I became acutely aware that while I received microaggression, the rest of her employees faced direct aggression. I remember thinking that her way of dealing with stress, by treating others like pin-cushions, was both unprofessional and unkind. She would usually target one person on any given day, or sometimes for weeks at a time. They received relentless redicule, demeaning comments, interrogation and agregious amounts of blame- for anything and everything. Sometimes people were targeted after making a mistake, sometimes it appeared to be random.

I was not quick to realize that her passive aggressive comments towards me were replaced by the cold shoulder technique. This cold shoulder, silent treatment and general indifference to my presence lasted a couple weeks. This was the calm-before-the-storm stage, and the air was constantly charged with tension. In the office, you could feel and see the tension enter the room with her. As just as it arrived, she took it with her when she left. I noticed employees sigh quietly with relief after she would leave for the day. It was until she left that I realized we were all holding our breaths, and figuratively navigating the egg-shell laden office.

At this point, I still chalked everything up to “she must be going through something, and like everything, this will pass.” Probably because I was trying to create the reality I wanted by altering my perspective. To employees who had been around for awhile, all of this was nothing new. Employees either silently accepted this as the way things are, or they quit. This lead to constantly revolving door of employees. Red Flag #2.


the Revolving Door

I was told employees were rarely fired because Dr. Cray didn’t want to risk them receiving unemployment. Instead, she used her own technique that she referred to as “driving them out.” She insisted the office manager do this as well. Basically, make them so miserable at work that they quit. Make working there unbearable.

During a 10 week period, 5 people were hired, 5 people quit, and 1 person was fired. Sometimes Dr. Cray decided she did not like a new hire (specifics were never given as to why or when she disliked them), and sometimes she just wanted new hires gone for no apparent reason. We knew this was coming when she would “flip the switch” and relentlessly target someone for no apparent reason. Everytime this happened, the new person quit. During my time here, no new hire lasted longer than one month.

Katie, a part time assistant manger, worked another full time job and had a third job, in addition to being a single parent. She worked for Dr. Cray for 10 years, and said this is the way things had always been. For the last 6 months, she had been trying to quit in order to take better care of herself and her daughter (health problems, fatigue and family emergencies). She was met time and time again with one of Dr. Cray’s emotional weapon of choice, guilt and shame. She gave a 2 month heads up that she would be leaving, with the hope that this would provide ample time to hire a replacement. During Katie’s last two months, Dr. Cray refused to acknowledge Katie’s presence…unless it was to scold, demean and guilt trip. She repeatedly pressured Katie to work on projects from home without compensation (yeah, for free!), since Katie was “screwing the business over by quitting.” During her last few days of work, Dr. Cray repeatedly told her “I hope you know, you’re really screwing me over.”

Like all the other new hires, Katie’s replacement gave her 2 weeks notice within a month of being hired. Upon hearing the news, Dr. Cray’s looked as if she’d just accepted a challenge from a rival.

“Oh yeah?” And as if making a call to arms, she said “Let’s make her last two weeks a living hell.”

When I heard her say this, the gravity of the situation finally hit me. After seeing her blatantly wage work-place warfare, and ordering her employees to engage in it, I did something I had not done up until this point.

I looked at her and calmly said “Yeah, I’m not going to do that.”

And ever since the moment I spoke up, things have been getting much much worse.

#veterinarian #vet #vetmed #vetlife #equine #horse #equinevet #ambulatory #mobilevet #veterinarypractice #dayinthelife #doctor #profession #equineveterinarian

That moment when you’re really glad you did…

Having never performed field castrations completely on my own, I served as the anesthetist while my boss performed the routine surgeries in barn pastures and backyards. Although her castration tool-of-choice is the Henderson drill, she took to demonstrating the different surgical techniques (open vs. closed) and cycled through the different types of emasculators with each castration. After watching five or six castrations, the opportunity for me to perform my first castration presented itself in the form of a laid-back, confident client and healthy six month old Thoroughbred colt. My boss kept a watchful eye from her position at the neck of the horse, while I talked my way through each and every step of the procedure. For the entire 20 minutes that it took me to perform the castration, my heart felt like it would pound right out of the chest. My hands trembled the entire time, and it wasn’t until I was done that the client said I did a thorough job. She said she knew I did a thorough job because apparently I narrated step-by-step the entire surgery. I was so focused, I wasn’t even aware that I’d done that. My first castration went well, and was without complication. Now, it was just a matter of getting a few more castrations under my belt before I’d be performing them solo in the field.

Unfortunately, starting out as a young doctor and being new to ambulatory practice, I ran into some difficulty getting consent from owners. On multiple occasions we hit this roadblock, when clients were not on board for allowing a “fledging doc” cut their colt…regardless of the well-seasoned and experienced veterinarian watching my every move over my shoulder. Each time the plan changed, the itch for experience got stronger and stronger. After 3 months, and having watched over 15 castreations, I was chomping at the bit.
When we showed up on the small mom-and-pop farm, the plan was for me to make another notch in my castration belt. The horse was a 5 year old Arabian stallion, recently purchased and barely halter-broke. He was so high strung and wire, that just the act of sedating him alone, was quite the feat for my boss and I. This ordeal was enough to change the minds of the clients, who recanted their original offer for me to perform the castration. I settled into my role as assistant and anesthetist, and tried to push the itch out of my mind.

Several rounds of sedation later, the colt was sedated enough to anesthetized with my boss’s ketamine protocol. He dropped quickly to his side, and we got to work positioning and scrubbing the incision site. Within a few minutes, he was starting to wake up from the anesthetic. My boss is one fast lady, and it takes her less than 5 minutes to castrate a horse. She placed the Henderson drill and spun each testicle off, she checked from hemorrhage and then gave him a rinse. About the time he was getting his antibiotic injection, the gelding was strong enough to push me off his neck and stand to his wobbly feet. My boss took his halter, and I helped balance his staggering hind end as we made our way toward the barn.
As he took several steps, a normal amount of blood slowly dripped onto the gravel..leaving a breadcrumb trail of red droplets. By the time we’d gone 150 feet, the slow drip became a fast drip…which then became a weak trickle of blood. In the stall, I called my boss’s attention to the steady stream of bright red blood coming from the incision site. I rounded up some gauze and fed it along as she packed it into the incision and simultaneously dodged his attempts to kick her. As she packed more gauze, the amount of bleeding increased. The gauze was drenched, and after packing three rolls in there, the bleeding was not improved. He was more awake at this point, and took to slamming us against the stall wall.
After several minutes, it was apparent the packing wasn’t going to be enough to stop the bleeding. A large blood of blood had accumulated, and the rate of hemorrhage was even greater. We made the decision to anesthetize him again in order to explore the incision and locate the source of the hemorrhage. The boss drew up the drugs, and we didn’t waste any time laying him down again. The amount of blood and the fact that he was only lightly anesthetized made identifying the bleeding structure difficult. Without good visualization, we worked somewhat blindly. The boss clamped some hemostats down on the part of the cord she could find and left them while she packed around the instruments with gauze. No sooner had she gotten the gauze mostly into the incision, did the gelding try to jump up onto his feet. I struggled to hold him down while the boss unclaimed the hemostats and packed the rest of the gauze. He nearly launched me over his shoulder as he made several attempts to stand. When he finally stood, the bleeding appeared to have ceased. Everyone breathed a sigh of relief, and the owners, my boss and I guided the horse to his stall for a second time.

I was in the middle of cleaning instruments when I heard a commotion from the barn. The owners went running past me towards the barn, and I could hear someone yelling help. “We’ll just euthanize him” the owners was saying as we all ran towards the barn. I had obviously missed something, and didn’t know who or what was being euthanized. “He’s going down!” The owners sounded panicked, and I arrived at the stall to see the gelding buckling his knees. “Just euthanize him on the lawn.” The husband said decidedly. My boss was helping to hold the horse against the wall of the stall. She looked mostly confused but there was a hint of some other emotion I couldn’t recognize. From between the gelding’s legs, blood was gushing down and into the shavings between his feet.

“What option do we have? We can’t put any more money into this.” The clients kept saying. My boss was now looking concerned, a look I haven’t seen too often. She usually exudes confidence, but definitely didn’t exude that when she was studying the profuse amount of blood coming from the incision site. The hemorrhage was significant enough that now I felt the real weight of the situations urgency.

“Your options? The referral hospital for surgery. Or we can euthanize him. Or we lay him down again?” The owners quickly shot down the hospital option due to finances and said to just euthanize him…and quickly before he collapsed in the stall and further complicated the situation. “Euthanize him?” There was no hiding the surprise in my voice. “We’ll just lay him down again.” I said. “I’ll draw up the drugs.”

“A third time?” The wife asked me.

“I’d lay him down 5 more times before going the euthanasia route. After I give him the drugs, he’s going to be out for awhile. He’ll be in a very deep sleep so we’ll have time to really get in there and find the bleed.” A Drew up my anesthetic protocol, a combination of ketamine and diazepam that put the gelding on the ground again, this time in a very deep slumber. After performing over 200 anesthesia at the internship, I developed a dependable anesthetic protocol and I have complete confidence in both my drugs and their dosages. My go to IV pre-mads are butorphanol and xylazine, and my induction drugs are a combination of diazepam and ketamine. A small bump of ketamine extended the anesthesia time, and kept the gelding out for the entire time that was necessary. My boss explored the incision site, welding handfuls of clotted blood and searching for the source of the hemorrhage. At one point, the gelding was so still my boss asked if he was still alive. As if right on cue, the gelding took a slow deep breath. I rinsed the area as my boss explored the cavity, feeling around blindly. When her gloved hand emerged, it was holding the end of a large bleeding vessel and shredded wisps of soft tissue. The testicular cord had been torn, which had resulted in the hemorrhage. My boss placed three transfixating ligatures, and afterwards we both studied it for bleeding. When no bleeding occured, she let the cord recede back into the incision.

“In 20 years, I’ve never had this happen.” My boss admitted. You bet we high-fived right then and there, bloody gloves and all. I was mostly just relieved. Hemorrhage is a real potential complication of castration, and it was the first real “bleeder” I had seen. While he slept off the drugs, we placed an IV catheter and started him on fluids. As the gelding recovered from his third round of anesthesia, we walked him back to his stall.

“Well, that’s one way to get to know the new vet.” One of the clients said as we packed up. “We were ready to euthanize him right here.”

“Well, not with Dr. Morgan here you weren’t.” My boss said as she gave me an appreciative look. Both clients gave us hugs, followed by a series of thank yous.

“Can tell you’ve done the whole anesthesia thing once or twice.”
I had to laugh when the client said this. All the hours spent running anesthesia during my internship, wishing I was doing anything but anesthesia. Counting down the days til I could turn in my anesthesia badge and never set foot in the anesthesia room again. And here I am, 5 months later, having one of those moments when despite all the weaknesses, hardships and trials that surrounded the internship experience, I’m really glad I did it.

#veterianrian #vet #vetmed #vetlife #equine #horse #equinevet #ambulatory #mobilevet #veterinarypractice #dayinthelife #doctor #profession #equineveterinarian