Joys of On Call

Re: Joys of On Call

vs0u — Wed, 05 Dec 2012 13:36:15 GMT

[quote user="Simon Neuhoff"]

[quote user="Anthony Dennison"]

The sour taste in the mouth was the few clients that would make an appointment, 'we'll be coming straight down'... 2 hours later I had to give up waiting and start my caesarian.

[/quote]

Thats why I ALWAYS make sure I get a contact number for them so as to phone and inquire where they are

[/quote]

Usually best to ring them back a few hours later, about 3am 'just wondering if you were still coming down - we've been waiting for you...'

That provides a little satisfaction!

Re: Joys of On Call

Anthony Dennison — Wed, 05 Dec 2012 10:45:23 GMT

The owners of my spinal case from the weekend requested a referral for further investigation to see what caused the problem. They went to the referral centre, who said exactly what I said (not sure of the cause, but it looks like it's affecting C1-C5) and are doing exactly what I'm doing (hospitalising, giving steroids and watching the day by day improvement).

Is it wrong that I'm feeling quite smug? The dog isn't insured so I mentioned MRI scans and further investigation at the weekend, but said for the cost of it they might not even find anything

Re: Joys of On Call

karen jones — Tue, 04 Dec 2012 23:08:50 GMT

Caller number display helps! Our nurses take the phone and have learnt to always get phone numbers or cope with grumpy moaning vets in the night. I take some pleasure in phoning people back to ask why they haven't arrived or to ask them if they're lost . At the moment trying decide if dare go to bed as one of our farmers has a Belgium blue Caesarian pending. Great set up and easy place to do one but still would rather not do at 2am.

Re: Joys of On Call

Thomas Johnson — Tue, 04 Dec 2012 18:00:46 GMT

[quote user="Stephen Courtney"]

Unfortunately clients often hang up before you can get this out of them, and sometimes they didn't talk to me but a nurse or receptionist who didn't get the details....and it always happens late at night or at the end of the day.

[/quote]

In my first and third jobs our phones were taken by an answering service, so I would then contact the client directly to arrange to see them if necessary. In my second job the nurses answered the phones, and while they usually got details they rarely agreed an exact time and there was a lot more waiting around, very frustrating. If I'd been in a more senior position I think I would have produced a protocol for them to follow...

Re: Joys of On Call

Utlendigur — Tue, 04 Dec 2012 17:22:28 GMT

[quote user="Stephen Courtney"]

[/quote]

I got a phone call from the RSPCA one weekend, wanting me to see a cat that had been "savaged" by the owner's lodger's dog.

Me "OK, what's his phone number?"

RSPCA "Oh, I didn't ask"

She had taken the surname - probably the second most common surname in these parts - and the street name - one of the longest streets in town.

Some time later the client phoned me directly - met them at the surgery and it turned out to be one of our serial bad debtors (hence phoning the RSPCA first?) - seen 8-10times previously, always "emergencies", never paid, notes about him being threatening - and as always p*ssed out of his head - cat had a miniscule scratch on one ear, probably from a thorn. Yet again I wondered when we might get a lone working risk assessment..... The previous time was a police call out when he and his wife, blind drunk, had taken the dog for a walk at midnight off lead down the middle of the road - I arrived to find him being restrained from punching the female driver of the car, his wife slumped under the front bumper next to the dog - and crouching down the examine the dog I knelt in some regurgitated, beer stewed curry . .

Re: Joys of On Call

Stephen Courtney — Tue, 04 Dec 2012 16:24:34 GMT

Re: Joys of On Call

Thomas Johnson — Tue, 04 Dec 2012 15:37:14 GMT

[quote user="Simon Neuhoff"]

[quote user="Anthony Dennison"]

The sour taste in the mouth was the few clients that would make an appointment, 'we'll be coming straight down'... 2 hours later I had to give up waiting and start my caesarian.

[/quote]

Thats why I ALWAYS make sure I get a contact number for them so as to phone and inquire where they are!

[/quote]

And always agree a time, even if it's only ten minutes from when you speak to them. I would always ask them how long it would take them to get to the surgery, add 5 or 10 minutes, tell them what time I would see them, and make sure they agreed. Learnt from experiences like yours!

Re: Joys of On Call

Simon Neuhoff — Mon, 03 Dec 2012 13:01:56 GMT

[quote user="Anthony Dennison"]

The sour taste in the mouth was the few clients that would make an appointment, 'we'll be coming straight down'... 2 hours later I had to give up waiting and start my caesarian.

[/quote]

Thats why I ALWAYS make sure I get a contact number for them so as to phone and inquire where they are!

Re: Joys of On Call

Anthony Dennison — Mon, 03 Dec 2012 12:08:19 GMT

Wow, and I thought I had it tough with my pnuemothorax post RTA, spinal trauma, caesarian and CKD cat to stabilise (amongst all the other CKD cats I bumped this weekend for the christmas clearout)!

Luckily they all have a happy ending too, pnuemothorax only needed thoracocentesis (pre and post rads are pretty cool), stabilised and went home, caesarian went fine, and my spinal trauma case has gone from being unable to walk at all on saturday morning and having repeated spasms to beign able to walk on her own (albeit quite wobbly) this morning... all hail steroids!

The sour taste in the mouth was the few clients that would make an appointment, 'we'll be coming straight down'... 2 hours later I had to give up waiting and start my caesarian. Oh, and the woman who made me miss my dinner to call me out and ignore all my advice I gave to her, 'do what t'other vet did, it was cheaper and worked'. *sigh*

Re: Joys of On Call

Stephen Courtney — Sun, 02 Dec 2012 20:36:10 GMT

I agree with comments regarding Elisabeth above - I'm know the new grad was very lucky to be supported through some potentially scary stuff. Not just doing the work, but the whole process of phone calls, arranging appointment, exam, discussion with owners, managing expectation, giving good estimates, obtaining informed consent, then performing tricky SA surgical procedures. And then doing something superhuman with bits of cow that aren't meant to be exposed to daylight...

Stuff like this makes me feel very inadequate - my heroism gene was blasted out a while back. I can remember that exhausted feeling of true satisfaction, from a job well done, but to be honest what i remember more clearly is the progression over the years of ever more intense OOH sessions as we got busier and expectations got higher - from ourselves as much as from clients - which meant being on call morphed into being 'at work' for potentially 36-48 hours. Getting a pair of dedicated night vets was a life saver.

Re: Joys of On Call

james herriot lied — Sun, 02 Dec 2012 19:46:36 GMT

[quote user="Elisabeth Knappett"]

Back to the OP

[/quote]

T'was me! Which is why I was hijacking my own thread........

But to all of your post above, Elisabeth, you're an absolute star - that's one lucky new grad

And tomorrow night, I'm on call and I suspect Karma will have something to say about my earlier gloating.

Re: Joys of On Call

Elisabeth Knappett — Sun, 02 Dec 2012 18:24:05 GMT

Back to the OP - feeling of satisfaction after weekend on call (not quite finished) of supporting newly qualified vet through a hugely obese old fat lab pyometra (closed and leaking internally) now fine, on her feet and home with grateful owner, ex lap and enterotomy on recurrent offender stone eating labrador (with more than a few adhesions making it a little more tricky) again back on his feet, wagging tail and drinking at the moment, cow prolapse back inside cow and several wobbles settled over the phone. One happy (ish) and capable newly qualified individual satisfied with jobs well done and feeling more competent than she started the weekend (PDP numbers obtained!!), many happy owners and treated and well patients settled at home. I may not have made the practice any money this weekend, and the owners/farmers may never know my involvement, but I'm happy. However, roll on tomorrow night - wine and Christmas tree here I come!

Re: Joys of On Call

Simon Neuhoff — Sun, 02 Dec 2012 15:28:44 GMT

[quote user="james herriot lied"]

Of course, there are also the joys of not being on call.

Just finished an extremely good lamb casserole, in front of the logburner, with a glass of ale and the telly on. Outside is a fairly constant driving sleet, into which I have neither duty nor intention to venture.

I may just open another bottle.

For those of you currently at work, you have my full and devoted schadenfreude (notwithstanding that I'll be in the same boat next weekend....)

[/quote]

I AM at work - till 4pm. It has been a pretty lousy day so far but currently we have regained sanity. If we can hold it together till 4 then I can thankfully join the rest of my family at a big Sunday late lunch - delayed in my honour. The wife will be driving so I might just open a bottle myself.....

Re: Joys of On Call

james herriot lied — Sun, 02 Dec 2012 14:52:52 GMT

Of course, there are also the joys of not being on call.

I may just open another bottle.

For those of you currently at work, you have my full and devoted schadenfreude (notwithstanding that I'll be in the same boat next weekend....)

Re: Joys of On Call

Jenny Smith — Thu, 22 Nov 2012 10:13:17 GMT

Had to share my joys of being on call case from last night (although a minor disclaimer, I only work OOH now, so not technically on call!) Had a cat presented open mouthed breathing, white as a sheet. Once a bit more stable initial bloods looked horrible, PCV 13, lactate 20, severe metabolic acidosis. But anaemia appeared regenerative and after a chat with the owner about guarded px etc, they decided to give things a try. To cut a very long story short, a blood transfusion courtesy of our lovely VNs cat and our collapsed dyspnoeic cat left the practice purring this morning. It was so satisfying being able to watch the cat improve over the night. The owners know there is a way to go diagnostically to figure out what caused the initial anaemia but at least they have a chance to try and find out now :) Very very cool case in a totally geeky way, but made all the better by the fact that staying up all night with this little cat was possible because I get to sleep today and be human again for tonight, which was the thing I always worried about when doing 'normal' on call

Re: Joys of On Call

Hanna Bennett — Tue, 20 Nov 2012 18:22:46 GMT

see other post, but, ahem, caesar, gdv and pyo after 6pm last night... five hours kip, finished at 2pm, not back on call til sunday and all doing fine. seems good to me...

Re: Joys of On Call

Anthony Dennison — Tue, 20 Nov 2012 11:26:03 GMT

[quote user="Michael Woodhouse"]There needs to be support, but new grads need the apron strings cutting too.[/quote]

I think I've said this before, but I look at it as being thrown in at the deep end with arm bands on.

Re: Joys of On Call

Michael Woodhouse — Tue, 20 Nov 2012 10:31:34 GMT

I think you are both right:

[quote user="Hannah Wynne Richards"]Someone has to attend cases like JHLs poor little mare at anti-socialhours-else they will die and die in agony[/quote]

[quote user="Dagmar Steele"]Where I live there is no shortage of OOH cover for small animals at all.[/quote]

I worry about the future of large animal, equine and mixed practices. There is also a tendency for certain large empire building, mainly dairy practices to cream off the profitable dairy work, forcing many mixed practices to small animal only. It will get to the point where smaller farms cannot get a vet OOH. I can also see huge recruitment problems if all the 'pet vets' don't do OOH but the large animal ones are expected to. Not everyone can afford to give staff the next day off, but you'd expect that bigger practices that were busier OOH would be more able to accommodate.

I expected that vets did OOH work, that was never a surprise. I am a much better vet having done so, and I do think that forcing you to learn when there isn't a full team around you is actually good, rather than passing the tricky case to someone longer qualified. There needs to be support, but new grads need the apron strings cutting too.

Re: Joys of On Call

Dagmar Steele — Tue, 20 Nov 2012 09:30:29 GMT

[quote user="Hannah Wynne Richards"]

Someone has to attend cases like JHLs poor little mare at anti-socialhours-else they will die and die in agony That's the bottom line-and those who aren't prepared for the committment are in the wrong job-and probably kept someone out of veterinary school who would be prepared for the hours

Wynne

(Good thing I'm not a shrinking violet as I expect the missiles will start flying)

[/quote]

You are just missing the point. I think most of us are prepared to look after that poor little mare (well, the mare would be really poor if it was me as I haven't done horses in twenty years) BUT they have to have time off to get a life in between. That's all I'm asking for and that is not only reasonable but also responsible. Where I live there is no shortage of OOH cover for small animals at all.

Re: Joys of On Call

Hannah Wynne Richards — Tue, 20 Nov 2012 09:25:37 GMT

Wynne

(Good thing I'm not a shrinking violet as I expect the missiles will start flying)

Re: Joys of On Call

Hannah Wynne Richards — Tue, 20 Nov 2012 09:16:48 GMT

Why not get the partner to drive to her?

Wynne

Re: Joys of On Call

Clive Ansell — Tue, 20 Nov 2012 06:48:06 GMT

[quote user="fluffygirl"]

Questions they should have in vet school final exams, no.32: A vet has a job in a busy small animal practice that does its own OOH. She works a 38 hour shift during which she manages to get 3 hours sleep. She then has to drive 50 miles in the dark in order to get home to her long suffering non-vet partner. Is it safer for her to drive a car with automatic transmission or one which has a manual gear box?

[/quote]

The only and correct answer would be: if you are exhausted after only 3 hours sleep in the last 38 hours, you should not be driving at all, it would be reckless and dangerous to do so, you could be putting the other lives at risk. You should have the facility to get some sleep at the practice, get a taxi, or get someone to collect you. If you had an accident through falling asleep at the wheel, as the driver you would be entirely responsible.

Second best would be driving the car you are most used to, be it manual or automatic.

Re: Joys of On Call

fluffygirl — Mon, 19 Nov 2012 23:24:26 GMT

[quote user="Lucy K"]

Ahhh thank you for those last few posts. As a pre-newbie (I qualify on March 1st), hoping to go into large animals, this kind of thing is balm for the soul.

[/quote] Questions they should have in vet school final exams, no.32: A vet has a job in a busy small animal practice that does its own OOH. She works a 38 hour shift during which she manages to get 3 hours sleep. She then has to drive 50 miles in the dark in order to get home to her long suffering non-vet partner. Is it safer for her to drive a car with automatic transmission or one which has a manual gear box?

Re: Joys of On Call

Anthony Dennison — Mon, 19 Nov 2012 22:54:17 GMT

[quote user="KMurphy"]

[quote user="Hannah Wynne Richards"]Anthony If you keep up that attitude you willbe a veterinary surgeon of whom the rest of the profession can be proud[/quote]

Or, God forbid, after only a few hours sleep fall asleep when driving and crash on the way home. It's good to be satisfied with your work but it is not acceptable to be working a full day on the back of next to no sleep.

[/quote]

Luckily my on call rota isn't too bad - 1 in 11, shortly increasing to 1 in 12. The way it works ends up with me doing one night on call a week for 3 weeks, then 2 weeks off, then another 2 weeks of one weeknight on call, then a full weekend, in the hospital and on call saturday/sunday night.

Admittedly I've had an unlucky run recently where I seem to get called out in the wee hours of the morning and have to stay out until start of work. If my boss sees that I'm completely shagged, I'll be sent home, or have a half day. On this occasion I got an extended, 3 hour lunch break so went home and had a quick kip, and I'm usually in bed by around 8pm (at the latest) the following day. Yes it is hard work and yes it can be tiring, but I'm never stupid with my driving. At uni I always pushed myself hard and worked above and beyond what was needed of me, as I knew that I could learn how to cope with long hours when I had the safety net of the clinicians and the buck didn't stop with me. Now I'm out in practice I've been thrown in the deep end (on my 3rd day I had a caesarian, on my 4th day a blocked cat) but I have full support and encouragement of the head vet who is my back up, even if I am calling her at 3am to say 'I'm giving this dyspnoeic bulldog furosemide and oxygen,that's right yeah?'.

So far in the past month alone of OOH work I have had spinal work ups, caesarians, blocked cats, RTAs, respiratory distress, cardiopulmonary resuscitations (well, twice on the same dog), plus so much more I can't think of right now.

The way my job works I wouldnt get to do this in normal working hours unless I was at the main hospital - I'm usually at branches with limited resources so anything complicated gets referred over there. OOH is when I get to learn my limits, learn how I cope with things and feel more like a competent vet, rather than during the day when I have the opportunity to second guess myself with other vets around to ask, despite usually being right.

To have the amount of experience under my belt 4 months in to my career that I have now wouldn't be possible without OOH work. Though then again, I'm a sucker for hard work.

Re: Joys of On Call

james herriot lied — Mon, 19 Nov 2012 20:54:19 GMT

Remember a foaling about 10 years ago (dawn on a Sunday so only car on the road), doing a ton-twenty down the main road. Little moor pony with an oversized and jammed foal, leg back and long dead. Sent the owner into the house and enlisted her next door neighbour to help. Could only remove the normally presented limb and was the only time I've ever had to put both feet on the mare to help with traction: I was convinced she was going to die from some kind of internal trauma, and revisited (FOC) 3 times that day just to look at her. She was fine, but we made a pact never to put her in foal again.

I can still remember the owner's primal scream when I told her the only thing we could do was pull and hope for the best.