When will this get easier?

Re: When will this get easier?

Jenny Smith — Sun, 05 May 2013 02:54:42 GMT

Probably thought in the current atmosphere of airing laundry I should add that I missed the first ever pericardial effusion I saw... I'm now an emergency and critical care vet!

Re: When will this get easier?

Jenny Smith — Sun, 05 May 2013 02:52:44 GMT

Hi Anon,

I'm a fairly recent grad (2011) and although I'm not in the equine side of things, I'd be more than happy to be someone to vent at if needed. Feel free to drop me a message on here. I work nights, so sometimes the hours I keep are a bit odd, but having someone to chat to without judgement is a big help. I found it hard to admit some of my mistakes to my friends, so a friendly and slightly anonymous shoulder is on offer if you need it!

Jenny :)

Re: When will this get easier?

Busybee — Sat, 04 May 2013 20:11:57 GMT

Hope the new Specsavers advert makes you giggle! We all make mistakes!

https://www.youtube.com/watch?feature=player_embedded&v=I3MUX3V0aUE

Re: When will this get easier?

bob lehner — Sat, 04 May 2013 17:19:45 GMT

[quote user="Evelyn Barbour-Hill"]I think it is the anaesthesiologist who has a problem.[/quote]'

'Anaesthesiologist' - is that what used to be called an anaesthetist ?

If that is what he/she calls him/herself then he/she has definitely got a problem.......!

Re: When will this get easier?

Evelyn Barbour-Hill — Sat, 04 May 2013 17:12:17 GMT

[quote user="An On MRCVS"] It was purely the reaction of the anaesthesiologist (screaming "Engemycin is an IV drug!") that was the problem I think![/quote]

I think it is the anaesthesiologist who has a problem.

Re: When will this get easier?

Niall Connell — Sat, 04 May 2013 17:09:02 GMT

I cannot add to the excellent advice already given by the others in this forum but I'd like to say you did exactly the RIGHT thing by sharing your concerns and experiences and looking for support! In my first year after qualification I must have left a trail of carnage a mile wide. Things will get better but if you're not sure, ask!

Re: When will this get easier?

An On MRCVS — Sat, 04 May 2013 12:26:13 GMT

Thanks so much everyone! This thread has really helped a lot.

I had a successful day x-raying 2 year olds yesterday so I'm back on the up again. The owner of the horse whose foot bandage fell off hasn't rung back again so I'm hoping that means my 3 inches of duct tape hasn't made it's foot fall off. The surgeon already gave him a 50/50 chance of recovery, however no doubt if the horse dies now it won't be the surgery, it'll be the couple of hours that the horse was wandering around with the hole in it's foot. The gentamycin that I injected perfectly uneventfully at the time but was then convinced at 2am had gone perivascularly, did not have a big vein the next morning and the nerve block that I eventually did on the right horse but was still lame afterwards also failed to block out to the one done by the boss.

Bob L: re the engemycin, yes in my panicked re-reading of the data sheet that evening I did notice that it's ok to give IM. It was purely the reaction of the anaesthesiologist (screaming "Engemycin is an IV drug!") that was the problem I think! That and the fact that it was a very good racehorse in training... Still all's well that end's well!

I had a quick word to the boss yesterday. He told me to stop worrying and being so girly.

Re: When will this get easier?

Bob Russell — Sat, 04 May 2013 10:58:09 GMT

We keep thank you's up on the boards in the office. We discuss, take necessary actions and reflect on the occasions someone is not happy, then file the letters!

It is really important to remind yourself about the many good things (and you have probably done loads of them already!), learn from and file the not so good.

It is very easy to dwell on the problems and ignore the good!

We have all been there and probably have those first few weeks indelibly etched on our brains. The only difference is you are going through it now and we have been there!

Yes it will get much, much easier!!

Re: When will this get easier?

Dagmar Steele — Sat, 04 May 2013 10:06:00 GMT

yes, very true, remind yourself of the things you did well! Unfortunately here in Germany people a re much more likely to complain when not happy than to give you flowers when all went well (we always say no news is usually good news...) Realizing how much some chocolates or a heartfelt thank you cheers me up I have made myself tell other people when I'm happy with their work. You wouldn't believe how much this is appreciated plus it makes me feel more happy in return, too!

Re: When will this get easier?

bob lehner — Sat, 04 May 2013 09:43:13 GMT

[quote user="SER"]

Also, we all forget the things that we did well! We take it for granted. It's like exams - you remember the questions which were hard, not the questions you answered well.

[/quote]

Yes - I think that is very true.

A compliment, card, letter or even a gift from a happy client is very nice and might give you a warm glow for a day or two. A major cock-up or complaint can stay in your mind for the rest of your life.

Re: When will this get easier?

Sara Ramsey — Fri, 03 May 2013 23:25:05 GMT

Also, we all forget the things that we did well! We take it for granted. It's like exams - you remember the questions which were hard, not the questions you answered well.

Re: When will this get easier?

Clair Firth — Fri, 03 May 2013 18:55:51 GMT

[quote user="Michael Woodhouse"]

Why would you give xylazine to dehorn? I've done some wild beasties with nothing more than a halter and procaine.

[/quote]

Uni Protocol! We give xylazine to sedate and then procaine for local.....

Re: When will this get easier?

Michael Woodhouse — Fri, 03 May 2013 17:56:56 GMT

Why would you give xylazine to dehorn? I've done some wild beasties with nothing more than a halter and procaine.

Re: When will this get easier?

Clair Firth — Fri, 03 May 2013 16:59:26 GMT

Similar to the "attempting to spay a tomcat" club, last week I tried to disbud a calf which had no horn buds Admittedly I am still a student but we were told by the farmer that all 5 calves in the pen needed disbudding - this was the last one, quite big (about 10wks old, 100kg) and lively so we got a halter on it and injected the xylazine without checking for horn buds! Calf happily sleeping and we found 2 hairless areas - had already been disbudded! Luckily no harm done and we left her sleeping in the pen.

I'm still a student but I know this won't be the last time something daft like this happens!

A month's internship at the anaesthesia & intensive care unit at uni was great for getting comfortable with anaesthesia though - animals stopping breathing was no problem at all by week 2! Just intubate and ventilate......as long as pulse ox was OK and the pulse was strong, it was fine! (I totally panicked when this happened the first week, by the end of week 3 I was left on my own (all the anaesthetists were in the OP) inducing a 1yr old healthy dog who after an initial apnoea finally settled into a "natural" respiration rate of 5/min! She was fine in the end!)

Re: When will this get easier?

bob lehner — Fri, 03 May 2013 14:59:42 GMT

Yes I think everyone agrees we are all fallible.

I vaguely remember seeing a survey a while ago re age distribution of VDS claims - I think I am correct in saying the worst lot was male vets over 55 years of age ....!

Re the original post - why the paranoia over i.m. Engemycin ? It's licensed for that route in horses and the data sheet just says 'A transient swelling may be observed following intramuscular administration in horses and subcutaneous administration in dogs.' Made by MSD a reputable company and been around since the Dark Ages - if there was a real issue with it i.m. I would have thought the data sheet would be a bit more specific by now . Let's face it horses can get a reaction to virtually anything given i.m. - especially if the animal belongs to the very worst kind of horsey-woman owner. (Personally I hardly ever used Engemycin in equines because my generation were taught that it would almost inevitably cause a lethal colitis - especially if given i.v - long since discredited I know - but I never got into using it anyway).

Re: When will this get easier?

tess — Fri, 03 May 2013 14:35:20 GMT

OP, everyone's advice is great.

I was a total stresshead when I started, and ended up being investigated for a gastric ulcer!

Things which helped me:

Ask your boss for feedback on how you are doing

Have an interest ouside of work

When the negative thoughts start crowding in, ask yourself "What can I change now, at this moment, by worrying about it?" The answer is usually very little especially during the night . All the scenarios you play out in your head never tend to happen.

My elderly neighbour who breeds dogs had some good advice- "Animals are not machines so you can't expect them to behave as such. Things will go wrong. Also humans are not perfect and mistakes are inevitable" Mistakes are there to be learned from- you may do it once but you won't do it a second time.

Find yoursel a rescue pet- if you are living on your own, the company is great.

I cut a large hole in a cat with a pair of scissors trying to remove a matt . The owner had brought it in because he was worried about damaging the cat's skin, and wanted a professional to take care of it. He was actually really understanding about it and the situation was lightened somewhat by the fact that his false teeth fell out onto the table during the consult.

It will get better with time, just hang in there and keep talking.

Re: When will this get easier?

Gerry Henry — Fri, 03 May 2013 13:07:34 GMT

You'll be fine but LEARN from every mistake and don't repeat it. The foot bandage thing is all technique, get someone who knows how to do it and what materials to use to show you, it can be a simple as using branded Elastoplast and avoiding the generic crap my wholesaler keeps trying to get me to buy. Don't lose heart and when the tables are turned in twenty years or so, pity that poor assistant.

Re: When will this get easier?

Hannah Wynne Richards — Fri, 03 May 2013 10:38:02 GMT

You obviously care-which will eventually make you one of the best veterinary surgeons around. The ones who end up menaces to the animal population are those who are OVER confident in the 1st few years-because they won't ever learn.

In the meantime, try to do something active, even walking which tires you out physically, make sure youeat well-even if you have to fork out for resteraunt meals, keep in touch with uni friends, even if you end up with a ginormous phone bill.

Try to find someone in the practice who will support you-it may be a fairly recent grad as someone suggested(though they can also be the worst for putting you down-as they're still building uptheir own egos at your expense)-it may be a nurse (though again,some are supportive and experienced-others have a massive chip on their shoulders because you're a veterinary surgeon and they were too thick when in school to get on the course)-it may even be the senior partner (it was a supportive boss who was in his late 50s who gave me confidence ).Just find someone in the practice you can turn to-and remember if you were going to be useless, then you wouldn't be worried

Wynne

Re: When will this get easier?

Bob Russell — Fri, 03 May 2013 10:12:39 GMT

I am now completely perfect! Diagnose everything correctly and can wear my 'Vet Hero' T shirt with confidence. All the clients love me, the patients adore me and lift legs in readiness for a blood sample to be taken! All injections are painless, surgery goes perfectly every time!

Oh and the sun is shining so all is well with the world!

The downside? This is all in my dreams!!

Don't panic, as everyone has written this is how it works in the early (and often later) days! I remember with horror the first calving I went to. The cow was down and my arm was stuck in still unfamiliar territory. Unlike seeing practice there was no vet standing by in case it all went t*ts up so everyone was looking at me! It went OK in the end, unlike the one on my first duty weekend. I waited on the farm for a very long hour until a more experienced vet could come out, spend a minute before confidently stating the dead calf held in place by adhesions would never come out and the cow had to go 'down the road'!

Just try to learn from your mistakes (in the old days there was the suggestion that you worked somewhere for a year so you could bury your mistakes!) and be as realistic as you can be!

It will be fine! Promise!!

Re: When will this get easier?

Wren — Fri, 03 May 2013 10:02:26 GMT

[quote user="Mark Rowland"]

Bloody hell is it washing day?

[/quote]

I hope so! If it is can I get rid of this one from the other week?

My first intra-arterial alpha-2 injection - I've managed to correctly put sedatives in horse veins for 14 years, until last week! Horse literally dropped of the end of the needle, crashed to the floor and lay down sleeping for 45mins. If I'd been in my first year in the job I'd have panicked like hell and expected it to die. Instead I was pretty cool, kept an eye on its pulse/heart rate/breathing/eye reflexes etc. and continued doing what I'd sedated it for in the first place. Eventually it looked a bit more lucid and stood up and because I'd been keeping an eye on how deep it was I was ready and got it to its feet pretty smoothly.

It probably helped that the owner wasn't there!

So what I'm trying to say, like Arlo, is that the disasters still happen, but you do deal with them a lot differently and they stress you out less.

Re: When will this get easier?

Dagmar Steele — Fri, 03 May 2013 09:50:08 GMT

Haha Mark, I have no problem admitting my faults and it always helped me to find out others weren't perfect either. It's the same when you talk to other parents, once you're admitting problems and the things you and your kids struggle with you find out everybody else has the same problems.

Re: When will this get easier?

Mark Rowland — Fri, 03 May 2013 09:44:07 GMT

Bloody hell is it washing day?

Re: When will this get easier?

Dagmar Steele — Fri, 03 May 2013 09:39:46 GMT

Excellebt replies and advice so far and yes, what you're experiencing and feeling is totally normal.

When will it get easier? Within the first year, but it will never go away completely. I am qualified for 23 years now and I still loose sleep over complicated patients and my mistakes. I still make mistakes, not as much as I made as a novice but I do. A very seasoned vet once said to me: "Don't wonder if you'll ever kill a patient, it's inevitable that you will. Better prepare yourself for it right now."

I have many stinky big mistakes I made, I'll give you a selection that came to mind last night when I was pondering over your post:

Locuming in the first year I spayed a bitch, only injectable anesthetics, I dosed too low and kept topping up which didn't work, bitch kept pressing the intestines through the wound. I somehow managed to finish and stitch her up but I was told she died of peritonitis a week later.

I cut off a budgie's foot when trying to remove the ring.

When medetomidine first came out I overdosed it ten times in a nurse's dog (recovered uneventfully).

I had a rabbit bleed to death when doing the teeth because I nicked the vessel at the back of the mouth.

I lost one of three sibling cats when spaying them due to no obvious reason other than anesthesia.

I overlooked a broken leg in a horse.

Most recent mistake (about three years ago, so 20 years into work...) I overlooked an urethral stone in a dog with ongoing prostate problems though it was plain visible on x-rays. Dog nearly died and had to have emergency surgery, needless to say the referral center had some comments for this. I admitted the mistake straightaway and insurance payed, which took the owners by surprise.

I've always admitted when I made a mistake even if they haven't been as obvious as the budgie's foot because that's what I think is right. People make mistakes, you cannot change this. But you have to learn from them and make sure they never happen again, this is what you owe to your patients.

I am sure I have saved many more lives than I destroyed over the last 23 years and made many lives better, many others recovered despite my treatment :-). Otherwise I would have stopped being a vet. I'm afraid you'll have to live with the fact that we are only human after all.

Re: When will this get easier?

Mark Hedberg — Fri, 03 May 2013 08:43:53 GMT

[quote user="Arlo Guthrie"]

being faced with an engine failure all on your own, in the middle of nowhere, in a single engined aeroplane (happened to me three times, no less).

[/quote]

3 times? I'd be having a brief word with my mechanic!

Re: When will this get easier?

Arlo Guthrie — Fri, 03 May 2013 08:32:31 GMT

In answer to the original question (when will this get easier), I'm going to take a stab at the answer and say: 6 months, but it's a curved not a stepped graph.

And what possible experience can I draw upon, given I'm not a vet myself?

My first six months as a qualified pilot were amongst the most terrifying of my life. All very well having learned the theory, but there's nothing like finding yourself in busy controlled airspace in your Cessna 152 (mixing with airliners for the first time), or finding yourself staring at a wall of cumulonimbus and wondering how the hell you are going to get where you wanted to go, or being faced with an engine failure all on your own, in the middle of nowhere, in a single engined aeroplane (happened to me three times, no less).

What I found is that just dealing with a given problem (successfully or not) made me more confident for the next time. Once my engine had died on me once, I was almost sanguine about it the second time. My radio call went from a high pitched scream: "Sheeeeiiiiitttt, someone heeeeelp me" on the first occasion, to an almost baritone: 'Mayday, Mayday, Mayday' on the second.

The other thing I found is that most problems are variations on a theme, so once I was confident with one particular thing, it had a very positive knock on effect on a whole range of other things.

This may be completely irrelevant, I just thought it might be of some comfort to consider that you're not alone, even outside the veterinary profession.

And yes, I give it six months. Not that you'll have a crap time till then, or that you'll never make a mistake afterwards.