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Category: Opinion

What’s the worst that could happen?

A few years ago, I noticed my family cat had a lump on her neck that seemed to be getting larger. We had it removed by the local vet who told us it was almost certainly benign, and that sending it off for testing would be overly expensive and potentially unhelpful, depending on the results.

These were my pre-vet school years, but I could still appreciate the ethical minefield of chemotherapy in companion animals, as well as the “financial to practicality ratio” of diagnostic medicine.

Although it’s always frustrating not to have a firm answer, we took her home in the hope that all was well.

Worst case

Upon returning home for a weekend recently, I happened upon another lump – much smaller, but in a similar place.

To be honest, it was so long ago I couldn’t remember if the lump was even on the same side, let alone in the exact same location, but my mind immediately leapt to the worst-case scenarios – a myriad of potential diagnoses flashed through my head, along with the treatment plans, prognoses, clinical signs, etc.

It took me a few seconds to slow my train of thought down long enough to remind myself of all the less severe – and also far more likely – causes.

Knowing

I’ve talked about the curse of knowledge before when it comes to working in any medical field – that once you embark on your veterinary training, you lose your ability to appreciate an animal in its own right. Every dog, for example, is no longer just an adorable bundle of fluff, but a walking, barking list of potential things that can go wrong.

They say doctors and nurses make the worst patients – and from experience with friends and family on these courses, I wouldn’t argue otherwise. It probably doesn’t help that, to know how to make the body better, you must also learn everything that can possibly go wrong: a sneeze is no longer just a sneeze…

On reflection I think it’s important to fight this instinct and to recognise that just because something can go wrong, doesn’t mean it will. It sounds nigh on impossible – and perhaps counterproductive, seeing as “planning for the worst-case scenario” and “expecting the unexpected” are all part and parcel of life in clinic.

Sit back and relax?

Nobody wants a vet that’s 100% laid back – it’s the capacity to plan and expect that causes such stress outside of practice, but is so valuable within it.

Switching off is never easy. It’s been said that being a vet is more a lifestyle than a job, and, though I’m still years from graduating, I can already relate.

That being said, I think it’s worth the try. It’s only through switching off that we are able to rest, recuperate and come back stronger. I believe we owe it to ourselves and our clients to try leaving the white coat at the office when we go home at the end of the day.

March 7, 2020
Interview questions

Whenever I meet veterinary students, I am often asked: “What questions should I ask in my job interview?”

For the past eight years, I have sat on the interviewer side of the table and have been asked some great questions.

Here are some I think – as long as it is relevant to your career goals – you could ask:

How many new graduates have you taken on in this hospital?

This is important if you are looking for a supportive practice that is accustomed to taking on inexperienced vets. You can extend this to ask: “How long do they generally stay for?”

Do you have a support system in place?

If the practice doesn’t, don’t go in there expecting it. If it does, it makes the practice accountable to what it says if the support structure is not in place.

What concerns do you have about me?

This is a great question I have used, but I have never been asked by someone I was interviewing.

This opens the forum for the interviewer to voice his or her concerns (if he or she wants to) and allows you address them right then and there.

Sometimes, it may just be a misunderstanding that stops someone from hiring you.

What expectations do you have of me?

The practice may have unrealistic expectations of you. It may expect you to take on too much with inadequate training, knowledge and resources.

It is better to have a conversation and develop an understanding or solutions around those expectations before you start.

What can I do that would make you feel that hiring me was a successful hire?

It is important for you to know your employer‘s markers of success from the start. You want to know if you can achieve them and if you are engaged by them.

What are the major roadblocks that you think I will come up against?

The practice may have experience taking on new grads, and seen what works and what doesn’t. Therefore, it helps to know what interviewer thinks you can do to overcome them.

Asking an interesting question – especially one that challenges the interviewer – is a really great way of being remembered.

March 2, 2020
Commonly held beliefs that don’t do us any good, pt 1
Belief #1: clients are an obstacle to overcome

“Clients are rude. They’re stupid. They don’t care enough about their animals, are inconsiderate, and have no empathy for us and the struggles we face. They’re demanding, unreasonable in their expectations and want everything for free…”

When was the last time you thought – or said aloud – any of these things, or heard someone else say it?

Make no mistake, you will come across people who are any or all of these things, but, in reality, most people are not. We’re just so damn good at ruminating about the handful of negative experiences we do have that we go totally blind to the examples of the best of human nature that we encounter on an almost daily basis as vets.

Human

Humanity can be so very cruel – just pick up any history book if you need to be reminded of our dark side.

Yet, as vets, we consistently see people sacrifice their valuable time and resources to bring creatures of a different species to us, to help them care for these animals.

They may bring them in later than you’d prefer and will often have limitations as to how much they are willing to spend, but what we tend to miss is the miracle that some human cared enough to do something to intervene in the suffering of an animal in their care.

This really is no small thing.

The good, the bad and the uninformed client

And that’s just talking about our problem-clients. Many of our clients are caring, committed, self-sacrificing, grateful and generous. I’m often astounded at how far some people will go for an animal they love, and I’m moved on a daily basis by the depth of connection and emotion that this usually selfish species of ours can share with animals.

Then, a significant percentage of clients fall somewhere in-between – people who have lives full of problems, and worry and duty, who are suddenly faced with the extra responsibility of an animal in need of veterinary care.

We often attribute the aforementioned traits to this group, but the reality is usually much more benign. They are mostly just a mixed bag of worried, stressed, frustrated, uninformed, confused, time-poor, broke, scared, preoccupied… and then we take it personally that they’re not overjoyed to have to come see us.

We perceive it as an insult and a belittling of our skills. We’ll react to them with moral superiority and a sense of injured pride – and in doing so we often push them from this middle group into the “bad client” group, whereas what we should be doing is simply acknowledge their concerns with empathy and address those concerns in a way that leads to the best possible outcome for that patient – that client – in that particular situation.

Words to live by

I keep a quote front of mind for when I find myself getting frustrated with clients:
- Never assume malice when stupidity will suffice.
- Never assume stupidity when ignorance will suffice.
- Never assume ignorance when forgivable error will suffice.
- Never assume error when information you haven’t adequately accounted for will suffice.
In other words – everyone is not out to get you or ruin your day. They’re just dealing with their own lives to the best of their abilities. Help them if you can.

But it’s about more than just finding ways to put up with clients. If that is your goal – simply to survive the clients until you get to work with animals – then you’re missing out.

Most of the happiest vets I know will tell you it’s relationships that matter. That sustained fulfilment comes from connection. Those very interactions – with those troublesome people who cross our paths 100 times a week – hold the key to the source of the biggest and most lasting source of satisfaction in our job… if only we let them.
February 25, 2020
No strings on me

No one likes change – it’s a scary thing. And there’s perhaps nothing scarier than spending five long years on the course of your childhood dreams, graduating and emerging into general practice, only to find that this might not be for you after all.

Obviously, I’m not speaking from personal experience, but, according to a two-hour seminar my year received from people who really have experienced this, it’s a lot more common than people might think.

But it doesn’t have to be scary at all…

No fear

I think it’s fair to say no one really knows what to expect from vet school until they’re there, and I imagine it’s much the same in the transition from degree to profession.

So far, I have loved every bit of my journey towards becoming a vet, and I’m still really looking forward to everything that’s yet to come. I hope, when I find myself in the real world, I’ll love it every bit as much as I think I will – but if that’s not the case, it’s nice to know so many other options are out there.

After hearing from speakers from large veterinary conglomerates, pharmaceutical representatives and civil service workers, it became apparent that our degree can steer us in so many different directions.

Different strokes

Just because you don’t go in that same direction as most of your cohort, it doesn’t mean those five years of hard work were in vain; veterinarians make very strong candidates in a variety of job markets, and your experience will immediately help you stand out from the sea of other applicants.

No one was lying to you when they said the vet course would teach you transferable skills. Vets are trained to work under pressure, both independently and as a unit, to problem solve and go the extra mile, as well as having a firm knowledge of biology, pharmacology, cytology… the list is nearly endless. Not to mention the extensive interpersonal communication skills that are drilled into us from day one.

The take-home message from the seminar was this: do what makes you happy. Don’t let yourself be bullied by the majority or be swayed by the views of family, friends or cohorts.

(im)Perfect fit

Only you know if something is a perfect fit or if it’s just not working, and the latter is not a failure; it takes a lot of courage to go against the flow and make such a big life-changing decision, but it turns out the rewards can certainly be worth the risks.

There are obviously benefits of having what some of our guest speakers referred to as a “real job”: regular hours, a more predictable work day and a more manageable work-life balance – although they all admitted they did miss working so closely with animals.

I’m still not sure exactly which line of work I’ll settle into in the end. When I was first applying to vet school, I always saw myself as a farm vet, but over the past few years I’ve developed a large interest in exotic species and wildlife. But as long as I find myself in a job I can come home from at the end of the day feeling both happy and fulfilled, there’s nothing else I could really ask for.

February 22, 2020
The third year slump

I never really worried about signing up for a five-year course; friends would gasp at the prospect, but I’d always laugh it off for a multitude of reasons.

If I’m being honest, the part of me worried about leaving the security of secondary school was quite happy to have a set plan for the next half a decade, with most of the major decisions already made for me. It also helps that I’m a bit of a nerd and I’ve always enjoyed learning – not tests, though sadly they seem to come hand in hand – and anyway is it really “work” if you’re doing what you love?

Food for thought

Almost three years on and nothing’s really changed. I still love my course and where I’m heading, and no number of exams could ever diminish the joy of learning something new. But at the same time, as I approach the halfway mark of my course, it’s hard to watch friends I’ve made along the way begin to plan life after their own courses.

When everyone around you is getting ready to begin their next chapter – discussing dissertations and job markets and other truly terrifying adult-sounding-topics – it can be easy to fall into a slump.

The traditional “half-way meal” organised by the third years does help to soften the blow somewhat (food being the ultimate comfort), and also serves as a reminder that getting this far really is an achievement, one we’ve all made together. It helps to think of the next half of the course as the vet student’s version of “the next chapter”, because the shift to clinical years really is a different world – or so I’ve been told.

“…even my avid-clubbing friends are starting to wind down now. The older you get, the more being surrounded by bouncing, wide-eyed freshers are going to take its toll” – says Eleanor Goad.

Mature student

It probably doesn’t help that I’m an old soul, but as you near your fourth year you can start to feel like you’re becoming the pensioners of the campus.

I’ve always been the kind of student who prefers an evening in with a takeaway than a night on the town, but even my avid-clubbing friends are starting to wind down now. The older you get, the more being surrounded by bouncing, wide-eyed freshers are going to take its toll.

I think the hardest part for me about still having so far to go is the constant desire to just get stuck in. When the Australian bush fires crisis began, veterinary professionals around the world migrated in to help and I would have jumped at the chance to have been one of them.

Preserve your virtue

Patience is key in any profession, but I think veterinarians acquire it the hard way. Nevertheless, there’s a lot we can do while we wait for graduation to arrive. Volunteering is the obvious example. However, if you can’t afford a flight to Australia, there are always issues to be tackled closer to home – working to preserve your local wildlife, perhaps at a rescue centre, is as good a cause as any.

Volunteering, work experience, blogging (ahem) or educating those around you on subjects of animal care and well-being are just a few ways you can spend your time in these pre-professional years.

It’s okay if you feel stuck, or in a slump, it’s a pretty common thing. Just don’t wish it all away too quickly, because I bet we’ll miss these years when they’re done.

February 7, 2020
Who runs the world?
Toward the end of my first year at university, a friend of mine stumbled upon a funny online student-made list of “things NOT to expect at vet school”. From memory, I think it included things we all related to such as Christmas holidays (curse you, exams), summer holidays (why, EMS, why?) and “a coolness status to rival the medics” (we are real doctors, I swear).

But what was probably the most relatable, and yet the one nobody really expects before vet school without already being in the know, is: “an abundance of men”.

Now, I’m not saying I signed up to the course for the sole purpose of a live action performance of It’s Raining Men, but, at the same time, you can’t help but be taken aback by the sheer volume of girls compared to guys the first time you walk into that lecture theatre.

While stereotypical – are women more likely to love all things cute and fluffy? – wonders Eleanor Goad.

Why, oh why?

Just to put it into perspective for you, my cohort for the year is roughly 150 students and 10% of those students are male.

According to gender statistics recorded by the Vet Futures project, it’s been like that for some time, in fact, the veterinary graduates’ ratio of female to male has only been increasing over the past few decades.

Nobody is really sure why. In human medicine the ratio is relatively even, so what is it about animals that strikes a chord with women more than men?
- A maternal nature?
- A love for all things fluffy?
Both these solutions seem a little stereotypical and, to be honest, we’re probably most unsure about the reason behind the numbers because nobody wants to touch this landmine of a topic with a 10-foot barge pole.

I really don’t have the answers myself, either – but it’s a curiosity I can’t not address.

Imbalance

I suppose I never noticed it growing up, or even doing work experience prior to vet school – which makes sense when you look again at the statistics as the gender gap seems to rein in after graduation. So, although around 70% of vet graduates are female, the number of practising female vets is more like 50%.

That difference doesn’t seem so odd once you’ve factored in maternity leave, but it’s not the only disparity. Despite the fact the veterinary population spewing out of universities across the country each year is overwhelmingly female, men make up the majority of those working as RCVS specialists, as farm/mixed practice vets and as RCVS fellows – the people committed to advancing the veterinary profession.

In essence, the vets who specialise outside of “general practice” are confusingly male. Positions of power in general practice, such as partner positions, are also held by men in a greater proportion than women.

How can this be?

As a veterinary student with, as yet, only a teeny tiny foot in the clinical world, I can only really speculate.

The best-case scenario for these statistics would be simple chance, that more men happen to have been interested in specialised careers than women, but this seems unlikely. It could also be down to the fact that maternity leave and childcare can unfortunately, but ultimately, lead to a lack of “career propulsion” (for lack of a better term), and can make it a little harder to advance in your profession at the same rate as male peers. More woman might choose job stability over returning to education or pursuing a less predictable career for the same reason.

These outcomes are understandable, but at the same time, nobody should be – or feel as if they are being – held back.

It’s my hope that, in future years, the gap between the genders closes, for more guys to aspire to a veterinary career, and for more practising female veterinary surgeons to pursue whatever career they chose, general or specialised.
January 22, 2020
Christmas: the post-game analysis

We’ve reached the other side of the festive season – and while those of us who had to work breathe a collective sigh of relief that it’s over for another year, I like to take stock.

Every year at the start of the season – as I brace myself to face the inevitable onslaught of vomiting pets, dog fights, snake bites, accidental poisonings, and all other manner of malfunction and malaise – it often seems to me the rest of the world is winding down to frolic on the beach and relax with friends and family (yes, here in Australia we frolic on beaches at Christmas – you should come over).

My first reaction to this was always one of near-crippling self-pity – “Why should I have to work while everyone else is out enjoying themselves!?” – and I’ve had to work very hard over the years on changing the narrative from “poor old me” to a more positive one.

Counting the positives

Here’s how I see things these days (this is not just an exercise in “silver linings”, but a genuine reframe of what is my reality):

Heroic

Whether it’s Christmas, new year or any other public holiday, these are the times I have the opportunity to be at my most useful and have my biggest impact. For the rest of the year, I’m like hundreds of other businesses – but this time of the year I get to be a hero.

I see it in the attitudes of our clients – at any other time of the year, people are usually somewhere between mildly annoyed and outright angry at having to use the services of an emergency vet. But not at Christmas – the vast majority of our clients seem genuinely relieved and grateful that we’re there to help them, and it’s very, very nice to feel appreciated.

Faith in humanity

I take huge inspiration from my co-workers. On public holidays I look around me at work, and find I’m surrounded by colleagues who – like emergency workers from all fields of life – are diligently and, for the most part, smilingly making sacrifices to make the world a little bit better for someone or something else.

My faith in humanity hits an all-time high during this time of the year, despite the crazies who inevitably crawl out of the woodwork during the holiday season.

No pressure

I have zero pressure to attend a family or social event that I don’t want to. A response of “sorry, I have to work” not only lets you off the hook consequence-free, but is usually met with “you poor thing, have some food.”

Post-Christmas frolic

My final motivator is a bit less enlightened: I take great comfort in knowing that when the rest of the lemmings start trudging back to the reality of their working lives, I’ll be taking a well-deserved break – when I can frolic on the beach without having to deal with all the crowds and madness they all had to deal with.

Be proud

If you are one of the many people who have sacrificed time with family and friends over the preceding month to make sure your clients are able to care for their animals, then allow me to say thank you. You should be proud of yourself.

I know I am.

January 15, 2020
You got a friend in me

Over the past three years, I’ve found one of the hardest parts about revising at home over the holidays isn’t actually the fact you’re revising at home, but that you’re not revising back at university.

Now let me explain, because I know it sounds odd…

Why would anyone not want to go home for the holidays, or right before some hideous, stressful exams? I will admit the food, festivities, time with family and pets is a nice bolster during revision (and certainly doesn’t hurt), but, at the same time, unless you’re fortunate enough to come home to someone studying the same course as you, and also preparing for exams, there’s nobody around you in the same boat.

One for all…

One thing I really miss when I’m at home, nose deep in textbooks, is that sense of camaraderie that comes with tackling the vet course with a group of friends.

Nobody wants to climb Everest alone, and it can be hard when those around you are enjoying time off and eating mince pies while you sit alone in your room, like the Grinch, muttering to yourself about hygiene laws and ethical quandaries of actual mince.

However, it’s not only during exam season that friends are so vital – they keep you company during the best and worst of everything uni has to throw at you. But, around exams, it’s not untrue that misery loves company. That’s not to say you can’t help pick each other up when the going gets tough, but if you’re all in the tough together, the going might not be so bad after all.

…and all for one

Group revision sessions with lots of chocolate, crisps (and maybe a few tears) are a godsend to me after days of seeing nobody but the animals on my flash cards.

Group revision sessions with lots of chocolate, crisps (and maybe a few tears) are a godsend, says Eleanor. Image © Prostock-studio / Adobe Stock

Spreading the workload among your friends is also a great way to make revision more manageable – and it’s true when they say teaching is one of the best ways to learn.

I’m so lucky to have the supportive network I do, and to know I’m not in it alone. On such a challenging course, it can easy for things to get on top of you (both academically and mentally), but by working together and leaning on each other, you won’t just survive uni – you’ll nail it!

January 7, 2020
A Merry Christmas for all the family

Little things you don’t consider until you spend every waking moment looking at, thinking about, or learning about animals, is how one of our favourite times of year might impact the smaller members of our families.

Awareness is rising on just how traumatic Guy Fawkes night can be for our furry friends, but there is a tendency to bring even more chaos inside the house during the Christmas period.

Anxious pets, or those used to a small household, can find themselves overwhelmed when the whole extended family comes stampeding through the front door – it’s often exhausting for us, so just think how they must feel!

The little things

Take little measures like employing a commercial pheromone infuser in the house a few days before the festivities start to kick in, or give your pet a safe and quiet room in the house away from the main action where they can take refuge. Make sure, of course, that they have plenty of food and water and, perhaps, some comforting items like their favourite bedding and toys.

Now don’t get me wrong, in my eyes Christmas is just as much about stuffing our faces as anything else, but making sure our pets don’t eat anything they shouldn’t is just as, if not more important, at this time of year.

A few things to watch out for include mistletoe, holly and ivy, which are often in plentiful supply at Christmas. Take extra care with house rabbits or any other pets that would normally enjoy tucking into leafy greens. Small pieces of tinsel, plastic bristles from artificial Christmas trees, or wrapping paper can also cause stomach problems if ingested – and nobody wants a festive trip to the vets or dog sick in their stocking come Christmas morning.

If you like to leave mince pies out for Father Christmas, make sure they are out of pets’ reach. Image © Chris Leachman / Adobe Stock

Festive food

Our favourite Christmas foods aren’t a good idea for our pets either, no matter how hard they beg. I know a lot of people are aware just how toxic chocolate can be to dogs and cats, but ingredients such as garlic, onions and alcohol are all equally dangerous. Mince pies also contain a lot of dried fruits, so if you like to leave some out for Father Christmas, take care to put them somewhere they can’t be snaffled before he arrives.

It can feel nice to include our pets in the festivities by giving them an extra helping at dinner as well, but a lot of animals have very sensitive stomachs when it comes to diet changes, and a lot of dogs and many cats don’t have the ability to “self-regulate”, which means they will keep eating after they’re full – a bit like us. This can make them really unwell and have the opposite effect the owner desired.

So, instead, the occasional biscuit treat or a new toy will probably go down just as well.

Teachable moments

Finally, teaching your family and friends all these little things can go a long way to protecting our pets over the holidays.

Little things we take for granted like cracker bangs, festive fireworks, a busy house and lots of food are all parts of Christmas that we’ll never lose – and quite right! But that doesn’t mean our furry friends have to suffer during what’s meant to be one of the most joyful times of the year.

December 22, 2019
Keeping the abdomen sterile when entering or removing part of small intestine

Here are some tips on how to keep the rest of the abdomen sterile while entering or resecting part of the small intestine.

Exteriorise segment

Exteriorise the segment of intestine as much as possible out of the abdominal cavity and use multiple moistened lap sponges to pack around the intestine to protect the rest of the abdominal cavity from possible spillage.

You can even go so far as using another fenestrated drape on top of your first set of drapes and passing the intestinal segment through it.

Instruments

Use a designated set of instruments for the enterotomy/enterectomy. I place them in a kidney dish to minimise the potential of contaminating the rest of my instruments, surgical field or table.

Allis clamp

I avoid using my fingers to grasp the foreign bodies as much as possible, despite the fact I may be changing gloves.

Instead, I mostly use allis clamps – they are commonly included in complex surgery or exploratory laparotomy kits, and the teeth and scissor action helps to grasp foreign bodies better.

Milk away contents

Before entering the intestinal lumen or removing a segment, I milk away the contents from the incision site(s) – both oral and aboral – and have an assistant apply pressure with his or her fingers with a scissor-like action, and/or use a pair of doyen clamps.

This reduces the risk of – or the amount of – leakage.

Kidney dish

I like to place a kidney dish under the exteriorised segment to catch any leakage, place the foreign body or resected segment of intestine in – and for any instruments and swabs I use.

The kidney dish then contains all the contaminated instruments, swabs and tissue.

Focal lavage

Once completed, I perform a focal lavage with syringes of lavage fluid into the kidney dish, or on to the lap sponges that have been used to pack off the area. Then I remove the used lap sponges, change gloves and replace the used instruments.

Lavage of abdomen

Finally, lavage of the abdomen. Now comes the tricky question – how much lavage fluid do you use?

For me, this depends on the surgery; you will find different answers based on what you read.

The common suggested ranges are between 100ml/kg and 300ml/kg of isotonic crystalloid (most commonly 0.9% saline), depending on the degree of contamination, with lavage continuing until the fluid comes clear.

I make sure the fluid is warmed, but not too hot. Another helpful tip is that you can buy laser temperature readers from hardware stores that can measure the temperature of lavage fluid – so getting it as close to body temperature as possible is so much easier.

Also, no benefit exists in adding antibiotics or antiseptics to the lavage fluid.

Suctioning as much of the lavage fluid as possible is also helpful if you want to track abdominal focused assessment with sonography for trauma (AFAST) scores, as increasing AFAST scores can help you determine if you need to go back in.

December 16, 2019