Quaking Hands

Yesterday and today I was the only vet in the clinic. Never my favorite scenario, but it went okay. Yesterday was dreadfully slow in the morning, today was busy all day long. I just recently got back from giving a goat a shot.

One of the good and bad things about being the only vet in the clinic or being on call is that I get to do things I would not get to do otherwise. Sometimes I wonder why I am not shown how to do things while other doctors are around. But I guess they are too busy. For instance, I performed my first dog cesarean section with no doctors and no technicians to assist. A little foolhardy, perhaps, but it went fine.

Today I did an intraperitoneal plasma transfusion on an alpaca cria -- never saw one done, never did one myself before. I had discussion with the owners regarding which side of the abdomen to insert the catheter. At OSU we did right-sided abdominocentesis on adult llamas, so it made sense to me that I would feed the plasma into that same spot (assuming that is the largest pocket of free fluid near the abdominal wall). As it turns out, Dr R feeds the plasma into the left side. Maybe this is better in crias as opposed to adults. Dunno.
We ended the discussion by finding notes regarding transfusion of another cria by Dr R, and I followed that protocol.

I shaved the left paralumber fossa, scrubbed it, placed a carbocaine block to numb the area. I poised my hand above the abdomen with the 14G 2" catheter grasped between thumb and forefinger. I began to insert the needle into the skin/muscle layers and then checked to ensure I was into the peritoneal space by advancing the plastic catheter ahead of the needle. If it slides easily, you're good. If not, you pull it back and advance the needle farther. I felt the pop as the needle entered the peritoneal space, advanced the catheter tube and pulled the needle out. I flushed the catheter with heparinized saline and drew back to ensure that, #1 fluid entered easily (indicating I was not between muscle bellies) and #2, I was not in the stomach. Both criteria met, we let the plasma flow
The owner commented "You're hands are shaking, that doesn't make me feel very good." Yes, I know. My hands shake when I am stressed, even when I have confidence that I can accomplish a task. It's that fear of "what if I fail," even though I know I have the ability to perform well. For instance, at the wedding last weekend, I started to shake briefly before I walked up the aisle. Not that I had any lack of confidence that I was capable of walking up the aisle, but stressed nonetheless. Fear of the unknown. Once I have done something once before, my brain has a pattern laid out and is much calmer. When I'm hypoglycemic and stressed, it's the worst. I guess if I was completely self-confident in spite of anything, my hands wouldn't shake. But it wouldn't mean I'd do a better job.

Conspiracy Theory

It feels like a conspiracy. I occasionally get cards from clients who appreciate my help with their pet. But rarely more than one in a week... and definitely not three or four!

Last week it was a card from a lady who was passing through and brought her panting, uncomfortable dog in to see us. I examined the patient and prescribed some medications. The patient was better by the next day. Was it the meds? Maybe, maybe not. But the lady was nice and appreciative and sent a card.

Later in the week, I learned that one of my special clients was transferring her records to another clinic. Great, so maybe I didn't communicate well, made her disgruntled, didn't produce good results in her pet and she felt the need to transfer her patient. I stressed about this somewhat seriously, analyzing the situation and trying to imagine other reasons for the transfer. The next day, voila, comes a card from the client... who thanked me for being her vet and explained she was transferring the pets because her daughter goes to the other clinic and it will be easier to have all the animals seen there since my old client is elderly and requires the help of her daughter. Of course, maybe there was more to the case than meets the eye... but no use borrowing stress.

This week a card from a guy whose dog I have seen since it was a wee pup. I guess I have enjoyed his dog and hit it off well in the exam room... but I haven't saved his dog's life or anything... all I did was neuter it last week, and here comes the card, detailing how the owner has confidence in me as his vet and looks forward to me being his vet for the "next 15 years." It's nice there are people out there who are willing to express appreciation for the small things in life.

Today one of my clients brought in ice cream bars for me and the clinic staff... because I talked her through a problem with her horse (suspected bee sting in a sensitive spot) one Sunday morning a few weeks back. To me it was a small thing. I didn't arise in the middle of the night, or even drive to her farm to see her horse. But she is one of those nice people willing to "say thank you" in a concrete way.

So, you see, it seems like there is some conspiracy... someone who knows I get discouraged and wonder if anyone likes anything I do... someone who knows "some people" think I'm not as good as the vet I replaced... someone who knows I need encouragement to keep my smile going.

I wondered if it was someone from the clinic.

But probably it is God.