Sunday, June 14, 2009

to understand

my job is hard. it is gross and sad and stressful and yet funny and full of joy. i love it. but it is hard to explain when i come home the range of emotions i feel during a shift.

we had a dog come in the other night. he had been acting not right, went to the local vet, had an exploratory surgery--dog had a GDV (stomach twist) and the stomach was necrotic (dead). local vet didn't resect (very complicated) closed dog up and sent dog + owners to us.

i went out on the triage. the dog was in the back of an SUV with a hatchback. the husband had come in to the lobby and the wife was in the back with the dog. the dog was a 10.5 yr old setter who was still drugged and smelled like necrotic bowel (if that means nothing to you, you don't want to know).

i thought the people were going to go for a second surgery because the stomach was dead and needed to be resected. the people elected for pain management and supportive care. when they came back to say goodnight to him the wife was talking to him saying:

"you can sleep on the bed when you come home. you can sleep up on the pillows and we'll go for a good walk and play in the yard. you can sleep in the bed. just pink up. let that stomach pink up. I just want you to come home and sleep in the bed with us."

'pinking up' means perfusing means blood going to the tissue means the tissue doesn't die. and in that moment, hearing her talk to the dog i saw the whole picture for a moment. in vet med we focus a lot on the moment, on the illness, the vital signs, because if you open yourself up to the whole picture, the raw pain of the client, you can't get through it. you care for their animals and you show them compassion.

but there are moments when it all slips in under your guard. when i see for one moment that dog as a puppy with these people, as a healthy dog, a young dog at home. i see 10 years of memories and i see the hole that's left because their dog is lying in pain at my feet. and i know it's not going home. but more than that, i see the hope that everything isn't lost, the hope that things can be the way they were. i see the whole picture like a slideshow and it all rushes in on top of each other.

and that's when it overwhelms me. that's when i go to the bathroom to cry or go wrap my arms around carbon and tell her how much i love her. because your whole life lives only in that instant and it feels like it will go on forever until it stops and then you can't go back, you can't have just one more day. you didn't know it was your last walk with him, your last night in the bed, your last game of fetch. and i see that all cascading on top of the picture in front of me on top of the patient, on top of heart rate, blood pressure, pulse quality, vocalization and posture, blood chemistry.... i see that whole life in the shadow of each moment in the hospital and i have to pull back, go to the safe place where i think about electrolytes, volume depletion, pain management, vital sign trends. because the other picture, of him playing in the yard with his family, that picture breaks me heart.


today we had a dog come in. he had my name. i was excited to have a patient with my name. i did the triage. the owners described symptoms that concerned me a lot but i could tell they didn't know how bad things were. long story short, the dog had a pericardial effusion, we tapped it, it had a heart based tumor (resectable but poor prognosis) and failed to improve after fluid resuscitation and chest tap. the owners elected to euthanize (a reasonable, kind decision). But they were a half hour away. so i sat with that dog on the floor while he woke up from sedation. i put his head on my leg and i wrapped my arms around him and said "this is how i hug carbon". i rubbed his ears and his head and under his chin and i told him he was a good dog.

and then he heard his family and stood up so i took him for a last walk outside before bringing him to be euthanized. bringing the animal into the comfort room is always a hard job. when they wag their tail for the first time since admit and walk with a bounce in their step it's even harder.

this time it wasn't so much seeing the life of the dog and the family's grief. it was wanting to say to them:

'your dog spent his last hours here in the hospital. but he spent them in my arms. he spent them with people who love him and rubbed his head and told him he was a good dog and although you were not here, he was not alone."

because that's a part of the medicine. i can't help but slip and place myself in their position, imagine it was my pet in the hospital. and i would want to know the person caring for him felt real love for the animal, that they knew how much i treasure and adore my pets. that they would treat my animals with the grace they deserve.

now i'm not saying all our patients our saints. in fact, it's often easier (emotionally) to deal with mean animals (we call them evil). they hiss, they bite, they scratch you. it's easier to distance yourself and stay in the medicine, the task at hand. we generally say that a mean animal will live forever. it's attitude alone keeps it alive.

but there are some patients. and when it sneaks past you, when you open yourself up, you can feel real joy as they get better and go home, real joy when they see their family and you know that you were part of that, part of the healing.

but sometimes it is just so hard. because i don't ever want to stop crying at euthanasias. i hope i get better at not actually crying at the time of the euthanasia because as the vet i'll have to administer the drugs, not just draw them up (although drawing up euthanasia solution is pretty damn hard too). but i think it should be hard. it should break your heart as long as your heart will heal. if that pain reminds you to cherish every day with your pet, reminds me to forgive carbon when she's a damn fool, reminds me how lucky i am this instant when she is driving me nuts.

then it's ok.

cause i love the science, the medicine, the procedures. i don't even mind really bad smells/fluids or the likelihood of being bitten on a yearly basis. i mean, i mind it sometimes. sometimes i just think 'this is the worst smell i've ever smelled" or "diarrhea, again? really?" and i spend my day cleaning up piss and shit and vomit. (actually, i did this today).

but that's logistics. it's the shadow of the dog in the picture that breaks your heart.

Thursday, June 11, 2009

i think i should update

since "dude, i went on a date and it didn't totally suck" i've been seeing ryan for about 2.5 months now and he is super sweet. and i'm happy. and like kissing him. so the earthworms were a positive omen, even if everyone else thinks its creepy

totally random

so i'm watching Diagnosis X on TLC and I feel like i recognize one of the guys playing a patient's friend. now, this happens a lot, since i watch more tv than god (the feeling that i recognize someone). i realize, though, that this guy reminds me of someone from highschool-someone from an upper grade. it took 15 minutes but i remembered his name--trevor algatt (correct spelling remembered too!) did a google search and sure enough, found an IMDB listing for him with Diagnosis X listed as a credit.

congratulations, older boy i never really knew but apparently recognized. I was probably standing in the background, awkwardly.

and to me and my freakish memory, congratulations joey. you are truly astounding.