Just A Day

Mar. 24th, 2017 06:50 pm
ladysprite: (new)
At this point, I've transitioned to doing hospice pretty much full-time. I still do relief work maybe one day a week, but I may be dropping that after this summer - I'm keeping busy enough that it's possible that relief time is cutting into my time to care for hospice patients, rather than giving me something to do when I don't have any hospice work.

Anyway, I realized that I haven't ever taken the time to write down what a regular hospice day looks like for me. So, just for the sake of anyone curious, and for my own posterity.....

Hidden, likely to get long.... )
ladysprite: (steampunk)
I love my new practice so much. And I'm utterly boggled at how quickly and well it's taken off. But I'm starting to feel a bit like Mickey Mouse in 'The Sorcerer's Apprentice' - like I've created something with no real idea of just how big it was going to get, and where it was going to take me, or how to keep it all calm and smooth and under my control.

My practice is growing. It's thriving. I'm getting word-of-mouth referrals; other vets are sending clients my way; people whose pets I've helped to pass are calling me in earlier to help support their remaining pets. I'm seeing more and more hospice cases, too - I've been booked all this week without a single euthanasia. People are calling me specifically to ask for help managing pain, or assessing quality of life, or just coming to terms with a terminal diagnosis and finding family consensus. And it's amazing.

I'm also, because I had to make my schedule for relief work several months ago, working 3 days a week doing 10-hour shifts with an hour commute each way. So I'm trying to squeeze all of these patients into the corners and spaces after work and on weekends, and using my lunch breaks (when I get them) to do callbacks. Most nights I've been seeing appointments and writing charts and answering work emails until after 9pm.

I swear I never expected it to go like this. I don't think I actually had any concrete expectations, beyond 'I'm going to try this, and we'll see what happens.' I sure as hell didn't think that I'd be this busy this quickly. I am delighted and excited and inspired and awed and grateful.

I am also exhausted as hell....
ladysprite: (steampunk)
It's been six months since I saw my first hospice patient.

In six months I've gone from wondering if the phone will ever ring, if I'll ever actually have clients, to wondering some days if it'll ever stop ringing.  I've gone from wondering if I was wrong to cut back on my relief hours to wondering how on earth I'm going to fit in all of my hospice work around the relief shifts I've booked for myself, and having to remind myself that I do need at least one day a week where I'm not working.

I've gone from shaking hands and wondering how on earth I'll manage to hit a vein without a technician to teaching other vets tips for how to premedicate their euthanasia patients painlessly.  And I've gone from 'I don't know if I can do that' to 'Maybe I can do that.'  It's a tiny change, from one angle, but a huge one in the grand scheme of things.

In six months I've gone from 'I found your name on a google search' to 'my neighbor told me to call you after you took care of their pet,' or 'my vet gave me your name.'   I've had clients write reviews about me on sites I didn't know existed, and blog sites feature articles about my services.

I've gone from all-euthanasia to a week where all but one of my cases are hospice, and people are calling me specifically to request palliative care for their pets.

I've provided hospice care to a pet rat.  I've held babies while their parents held each other, I've climbed into more beds than I ever anticipated, and I've apparently become a source of neighborhood gossip as to why the spooky white van shows up in my driveway every week or so.

And, not to put too fine a point on it, I've gone from four figures in the hole to five figures of profit.

I still haven't fully organized my office - there are still crates of medical supplies arrayed across the floor, and I'll admit that while my electronic records are pristine my paper files are rather haphazardly scattered across desks and in boxes.  But I have an office, and I have files.

Next month I'm going to the International Association of Animal Hospice and Palliative Care's annual continuing education conference - and for the first time, I honestly feel like I won't be a tourist or a fraud when I go.  I'll be new, still, and learning.... but I can honestly say I'm a hospice practitioner.
ladysprite: (steampunk)
I realized that yesterday was the two-month anniversary of me seeing my first patient through Autumn Care & Crossings, and I figured I ought to take a little time to note how things have progressed since then.  It feels like it's been longer than that, and in a way it's hard to remember that I've only just started doing this.

I didn't know quite what to expect when I started my own practice - how long would it take to get clients?  How many would I get?  How much would I be able to earn?  I figured it would take a while to get rolling, but I didn't have a mental image of what that while would be.

At first, almost all of my calls were for euthanasias, and I was afraid that that would be all I wound up doing - another vet with a similar practice in Connecticut told me that, while she wanted to do more hospice, it was almost impossible for her to market to people.  But over the past few weeks, that's changed drastically.  I've got at least half a dozen hospice patients already, and I'm getting more and more calls.

I'm already earning enough through hospice that my business is self-sustaining - I can afford all of the supplies I need to continue practicing from the income from house calls.  Last week I earned more from house calls than I did from relief work, for the first time.

Most of all, I'm loving everything that I do.  This is every bit as deep and rewarding and powerful as I imagined it being.  I love going into people's homes and meeting them and their pets, and I love the depth of understanding I'm able to get from this different doctor-client-patient relationship.  I love knowing that I'm helping people as well as pets, in a challenging time.  And even the euthanasia-only patients are more powerful than I ever imagined - I'm able to make something difficult into a more loving and less traumatic event, and I feel like I'm part of a shared ritual instead of just a medical procedure.

I'm not done growing yet, by any stretch of the imagination.  But.... I am so incredibly glad and lucky that I decided to make this leap.  I can't wait to see where it grows from here....
ladysprite: (steampunk)
In the middle of everything else, I'm still, y'know, starting a practice.  Appointments have calmed down a little after the initial flurry, but that just means I have more time to keep up with continuing education and to write for my hospice blog.

In particular, my most recent thoughts are about aging in animals, and how a lot of problems that are attributed to aging are often treatable conditions - check it out, if you want....

http://autumnvet.com/category/blog/
ladysprite: (steampunk)
I had my first official appointment for Autumn Care & Crossings today.  I guess that makes it real, now - I'm a business, with  clients, and income.

(Yes, I promptly spent that income to buy the last few items I need - a wheeled stretcher and a baby scale - but still.  It's a step in the right direction.)

All in all, it went surprisingly well and smoothly.  It helps that I've done house-call euthanasias before; just never as my own business.  As I get more experienced at this, I'm sure I'll streamline the process of getting charts prepared and invoices printed and my bag stocked and my controlled substances logged and the crematory contacted.  It's a wake-up call as to just how much of the business I was isolated from as an associate and a relief vet; I was used to always having someone else to handle most of the paperwork and the before and after details.  Still, it feels good to have a plan, and to know that that plan works.

And it was nice that the client wasn't a friend - it means that, slowly but surely, word is getting out about Autumn Care & Crossings.  I'm nowhere near self-supporting yet, and I don't expect to be for a long time, but it's still a good sign.

And most of all... it felt good to be helping.  I did something today that made a difference.  Because I started this business, I was able to make a difficult and painful situation better for people who were hurting and an animal who was suffering.

That's why I decided to do this.  And I'm glad to finally be on that path.
ladysprite: (steampunk)
I haven't updated here recently, mostly because my life has been silks and business, and for the last week or so I've been driving myself rather harshly trying to get Autumn Care & Crossings up and running.

I have a website (http://www.autumnvet.com in case you missed it!). And a phone line, and I'm all set up to take new clients.  The only problem?  I don't have any clients.

I've been working obnoxious hours trying to get the word out.  I've set up webmaster tools, and made a Yelp page, and sent out press releases to over a dozen local newspapers, and designed and printed brochures, and spent most of a week driving around handing out brochures and cards to clinics I've worked at in the past.  I've asked folks to spread the word (hey - if you're reading this?  Tell people I exist).

And now.... I wait.  And worry, and wait, and worry.

I know it's been less than two weeks.  I know these things take time.  But I also need income to pay my bills.  And... I've poured my heart and soul (and savings account) into this, and I'd hate to see it not just fail but never even start.

I'll get there.   Clients will come.  It'll just take a while.

I hope.....
ladysprite: (steampunk)
All right, then. I've done all the stalling and busy-work and prep-work I can. It's time to actually *do* this thing.

Autumn Care & Crossings is live. I'm ready to start booking appointments. I'll be spending next week getting my inventory ordered, and I may not have the laser at the very start, but if I start booking now I'll be good to go by the time I have appointments lined up.

So. Here we go - now all I need are patients, and, to get those, people to spread the word.

http://autumnvet.com/

If you're local, please feel free to share it around - the more people who know about this, the better.... :)
ladysprite: (steampunk)
There are some jobs for which "don't bring your work home with you" is sage and reasonable advice.

Actually, I suppose it's good advice for all jobs - it's just more feasible for some than it is for others. I promised after my poor brain-damaged midget kitten that I wouldn't bring home any more heartbreak cases, but I knew somewhere inside, even as I said it, that it wouldn't last forever.

Hidden, for length and rambling..... )
ladysprite: (tangy)
I had some downtime at work today, so I got the chance to catch up on some of my professional journals. And, in doing so, I ran across an article about the importance of performing a full physical exam on all patients.

In particular, it went on to define a physical examination as 'the routine assessment of a patient by using our five senses...'

I would like to take this opportunity to state that, no matter what anyone, up to and including the licensing board, says, I AM NEVER LICKING MY PATIENTS.
ladysprite: (steampunk)
So, to make up for last week's super-jerktastic client.... I'm back at the same clinic today, and the first thing I saw when I came in and set down my bag was a card on top of my desk, with a post-it note from one of the techs saying 'This may make up for last week....'

It was an incredibly sweet thank-you note from a client, thanking me for (of all things) treating their pet for a fairly simple and easily-treated problem. That almost *never* happens.

It's so easy to remember the bad clients; it's important to remind myself that the good ones exist too. This is why I keep coming back....
ladysprite: (steampunk)
So I was at work today, bustling from visit to visit and from pet to pet, and eventually I wound up in an exam room with a client, their child, and their pet, who was in for a routine checkup. And since I like (friendly, intelligent, well-behaved) children, and since it's Friday and I'm looking forward to a good weekend and I was in a good mood, I was taking my time and chatting with the family.

And the child in question clearly loved the pet thoroughly, and was a bit concerned about what was going to happen, so I did my best to explain as I went through my exam - how I was listening to the heart, and checking the eyes and ears, and feeling the belly and the legs. And because the child didn't want to see any needles, we took the pet out of the room when it was time to give the vaccines and draw a blood sample.

When we came back into the room a few minutes later, the child looked at the animal, then up at me, clearly a little worried, and asked why the pet was licking at its leg. I explained that we had wet the fur with alcohol to make it easier to take a blood sample. And at that, the child's expression transformed from one of mild worry to serious concern, as they looked up at me and said,

"But... if you drink alcohol, you can get sick! And you have to be 18 years old, and my pet isn't old enough!"

I'm not quite sure how both the child's parent and I managed to keep straight faces as we reassured them that no, the pet would be fine, given the circumstances....
ladysprite: (steampunk)
Okay - given that I'm stuck home sick today, and have nothing better to do, and that this has been on my mind for a while and has become more and more of a challenge I'm facing at work, y'all get Advice From Dr. B today. Namely, When Should I Bring My Pet To The Vet?

I think this falls into the category of something it never occurred to me that I would need to explain to people, but that in retrospect seems completely reasonable. For someone who's not a trained medical professional, it can be hard to figure out what's important, what's urgent, and what's emergency. So, here goes - what should you bring your pet in for, and on what kind of time scale?

Hidden for those who don't have pets, or who don't care.... )
ladysprite: (steampunk)
Meanwhile, in the middle of everything else, it's time for another Letter From Your Veterinarian.

Dear clients,

I've told you this before, and I'll tell you again - Do Not Lie To Me. Seriously. In particular, do not lie to me about whether you're actually giving your pet their medication. Especially particularly when it's for a chronic, potentially life-threatening condition.

If you tell me you're not giving the meds, or not giving them as directed, I won't hate you. I won't yell at you, or punish you, or tell you you're a bad person, or take your pet away, or anything like that. The worst I will do is remind you, as politely as I can, that it's important to give the meds, and that they won't work as well on your counter as they will actually inside your dog.

If you lie to me, and tell me that you're giving them as directed, and haven't missed any doses, I will be forced to then wonder why your pet isn't getting better. And this will lead to one or more of the following situations:

1) I go on a hunt to find out what else may be wrong with your pet. This is likely to involve extensive diagnostics that take time (and precious bodily fluids) and cost money. Bloodwork, ultrasounds, timed tests that involve fasting and full days in the hospital, as I try to figure out whether your dog has concurrent infections, cancer, organ failure, or goodness knows what else. it This will lead to stress for your pet and significant expense (hundreds, possible thousands of dollars) for you.

2) I change your pet's medication dose and/or type. This is the potentially *really* bad one. If your pet is on half a pill twice a day, or 2 units of insulin, or suchlike, and it's not getting better, it may need more or different meds. If your pet is actually on zero units of insulin, and it honestly only needs 2, and I ratchet the dose up to 3 or 4 because I don't have the proper information, you have a potentially seizuring, critically ill animal on your hands. Or, if I change meds entirely, odds are I'm changing to one with more potential side effects and risks - there's a reason we don't use those things as our first choice.

3) I refer you up the line to a specialist. This is likely to lead to significant waste of time, money, and energy, as well as lead to possible medication problems, and will also wind up with you shuffling between multiple vets. And ultimately, if my complex, drug-resistant case winds up with a diagnosis of 'Client lied about meds,' I'm not the one who looks like an idiot. You are.

So. Truth means accurate treatment, higher chance of a healthy animal, and maybe a stern look. Lies mean potentially hundreds of dollars of unnecessary diagnostics, days of hospitalization, and serious risk to your pet's well-being.

We clear on that?

Good.

Love,

Your vet.
ladysprite: (momongo)
I was working at a new clinic today, so I didn't quite know what to expect - I had been there once for a meet-and-greet, but that doesn't necessarily tell me much about what I'm actually going to find when I get there. Like, what are the nurses going to be like? Or how busy is the day going to be? Or what animals will be in the hospital?

In today's case, the answer to the latter included a tiny, 3-week-old gray and white kitten who had apparently been found in a Dumpster yesterday (left behind while mama-cat was moving the litter) and brought into the hospital to be taken care of. A very loud, utterly adorable kitten, with a little sticking-straight-up paintbrush tail, a constant need to cuddle, knead, and purr, and a need for a forever home.

I don't need a new kitten. I wasn't looking for a new kitten. Except, in one very tiny corner of my head, I kind of was. I love Moxie - I always will - but she's not exactly a cat. She's an autistic tribble. And Percy is, honestly, getting on in years. He doesn't act like a 15-year-old cat, and I hope to all the powers that be that he lives to be 25, but.... he's older. And even if he weren't, it'd be nice to have two cats again. And a tribble.

The schedule was light enough that I managed to spend a significant chunk of the day with said kitten curled up in the crook of my neck, purring enthusiastically. I tell myself I'm not making any decisions yet. I tell myself that I already have a gray-and-white cat, and that I like orange cats. I tell myself that I don't need another pet.

I told the practice owner that if he doesn't have another home for the kitten within two weeks, to call me....

I am a sucker.
ladysprite: (Default)
I've always known that my job would throw curveballs at me, and I had always kind of figured that I was more or less prepared for most of them. Even if the challenges were the sort of thing that you can't prepare for in specific, I thought I knew the general forms they'd take. Coping with death, and emotional turmoil. Facing down icky bodily fluids. Physical risk and danger. Trying to educate the recalcitrant.

Yesterday I faced a challenge that had never even begun to flicker at the edges of my consciousness as a potential obstacle. Namely, how the heck does one handle taking care of a pet that has the same first name as your mother?

I tried, I honestly did. But standing there, petting the critter and saying, 'Good girl, M____,' 'Has M___ been using the litterbox well?' and 'Sit, M___! Down, M____!' and 'Be nice, M_____, and let me check your ears now,' just felt WAY the heck too weird.

After a few minutes I just cracked up, and then took a moment to explain the situation to the client, who graciously (and amusedly) didn't complain when I made it the rest of the way through the appointment referring to her pet as 'sweetie.'

Still, there's a part of me that can't get that creepy-bizarre juxtaposition out of my head.....
ladysprite: (momongo)
Sometimes I feel like all I do is gripe about my job. Lately it's been long hours at overbooked clinics, with sick animals and underfunded or high-maintenance clients, and I've been starting to wonder if I was burning out. And then something little happens, and I remember why I love what I do.

Earlier this week I showed up at work (at an old favorite clinic, which makes it even better) and found that the extra exam room had been closed off. Apparently the head tech had arrived at the hospital to find someone already waiting in the parking lot, with a stray cat they had found. (Or, to be more accurate, a stray cat that had found them; it showed up on their porch and tried to get in the house.) Not sure where else to go, they brought it to us, since we were the nearest hospital.

The tech had scanned the cat, and found out that he had a microchip - and that he had apparently been a patient at the clinic.... in 2005. She then set him up in the extra room with food, water, litterbox, and bed, and we spent the rest of the day hunting down current contact information for the owner.

Five hours and half a dozen phone calls later, we finally found them. And found out that the kitty in question had been missing for nearly a month. In less than half an hour we were treated to a tearful reunion (the owner did her best to be stoic and unimpressed, but once she and the cat were reunited, I think everyone in the hospital started getting a little sniffly).

No impressive medicine, no dramatic surgery or heroics, no defying death... but still, this is part of my job. And it's not something that everyone gets to do on a daily basis. And it was just what I needed to be part of, right now....
ladysprite: (Default)
Sometimes veterinarians joke about how the people we have to deal with are the worst part of our job. Usually, it's just that - a joke. But it's funny because sometimes it's actually true.

My job is to help make your pet healthy, and to help keep it that way once we get there. And I'm darn good at it. But I'm not a miracle worker, and I can't live in your house 24/7, and I don't have a pocket full of instantaneous permanent cures. So you need to be an active, participating part of your pet's health care, whether you like it or not.

Pets are like children - they cannot be relied upon to always know what's in their best interests, or to always make the right decision with regards to their own health and well-being. These are creatures who will swallow rubber clown noses whole, chew on power cords, and eat their own body parts when something seems wrong. It is your job as the sentient member of the relationship to occasionally make rules and enforce them, and to occasionally do things to or for them that they don't want done.

You are the human. You are the boss, not the animal. And I am sick and tired of people telling me 'He won't let me' when I tell them what they need to do for their pet's health. Or (my personal favorite) pointing and laughing. You are the primate, you have the thumbs, how the heck is your pet going to refuse to allow you to do (X/Y/Z)? It's kind of hard for them to hold a gun on you. If your pet is the boss in your relationship, it's not cute or adorable or funny or sweet. It's unhealthy, and a sign of poor pet care bordering occasionally on neglect.

If you own a pet, you should be able to:
-hold it
-pick it up (unless it's too physically heavy)
-touch its feet, face, and ears without getting bitten or having it throw a temper tantrum
-give it oral medication (yes, anyone with two hands can do this)
-perform the minimum necessary grooming to keep it healthy
-put down a bowl of appropriate food and have the animal eat it (discussions of what is appropriate are a separate rant)

If you have a dog, you should be able to put its harness/collar on yourself, attach it to a leash, and take it for a walk without it choking itself, trying to pull your arm out, or insisting on being dragged.

If you have a cat, you should be able to get it into and out of a carrier by yourself.

If you have a small pet that lives in a cage, tank, or other enclosed habitat, you should be able to pick it up and handle it safely, and clean its habitat. If handling it requires using safety equipment, you should have that safety equipment on hand at all times, and be comfortable using it.

If you cannot do these things, there is a problem, and odds are the problem is you. There are occasional exceptions, true, but they're pretty darn rare. If you don't know how to do these things, it is your responsibility to learn. If you know how, but your pet won't "allow" you to, it is your responsibility to work with your pet and train it until you can.

Because I am sick and tired of having animals become ill, suffer, and sometimes die because the owner "just can't" give it the necessary medicine, or feed it properly, or see to basic hygiene. This is neglect. Not the obvious kind you see on Animal Cops, where the animals are emaciated and covered in sores and filth, but neglect all the same - when I have a dog come in screaming in pain because it can't poo because there's a ball of feces the size of both my fists matted in its fur; when I have a pet come in bleeding from its face because its teeth are so rotten they rotted through its skin; when someone tells me to euthanize their pet with an entirely simple, affordable, treatable condition because it's too hard to give it medicine; when someone tells me that they can't bring their pet gerbil in because they can't get near it and so it survives by them just throwing food into the cage from a distance - that's a failure of good pet ownership.

Toys!

Jan. 31st, 2012 01:09 pm
ladysprite: (momongo)
I have never thought of myself as a gizmo freak or a techie - if anything, I tend to self-identify as something of a Luddite, at least for a geek. I don't work with computers, and they don't fascinate me - I know the minimum necessary to check my email and write invoices. I don't have a smartphone, and I don't know if I ever will. I was the next-to-last person I know to even get an MP3 player (the only person I know who is less of a tech-toy fan than I am is, strangely, my scientist husband - and I think a lot of that is just his general aversion to Stuff.).

And I always figured that this was just intrinsic to me - that I'm more of a do-er than a user, that I prefer hands-on experiences to using tools. I'd rather knead bread by hand than use a bread machine, hand-sew than fight with a sewing machine, I even take notes and write stories better longhand than I do on a keyboard. But then I had the major exception in my rule pointed out to me - medical gizmos.

I can't help it. Diagnostic gizmos are just freaking cool. Yes, hands-on medicine is still good, and important, but there's something just intrinsically awesome about playing with new tools that beep and flash and DO SCIENCE that makes my inner geek light up in ways that my Ipod never will. I finally had this driven home last week, when I went to test a dog for glaucoma and found out that the clinic I was working at had the brand-new, remodeled, latest-edition tonometer (a tool that measures the pressure in the eye) that I had never had a chance to try before.

I may have bounced up and down with excitement. I know I was grinning like a fiend, and burbling delightedly to the tech about how shiny and spiffy it was, and that I had a tough time not wanting to test it out on every other patient that came in that day. (For the record, it works like a dream compared to the clunky, awkward older ones. Also, the dog totally did have glaucoma, and thanks to the spiffy toy got the emergency treatment necessary to save its vision.)

I'm not sure whether this realization means that I'll ever come to love tablet computers and online games as much as anyone else - I think that's a part of the geek nature that's just missing in me. But I'll admit, it does make it much more likely that I'll break down and buy myself the high-end ophthalmoscope that I've been secretly pining for....
ladysprite: (momongo)
There are so many more reasons I could go into right now - I love my clients, I love my coworkers, I love the fact that I get to learn new things and put them into use, and there's a whole big post I want to make when I get the chance, going into detail on some of these subjects. But right now, the biggest and boldest reason I love my job?

Because it is the sort of job where my professional association feels the need to put out a press release on the subject of 5 Reasons Why You Want A Veterinarian On Your Team In A Zombie Apocalypse.

And it's all true. And I love it.

My job is awesome.

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