Is it a brain, skull, or something else??? (Day -283)

I remember many years ago watching ER with Carter dealing with a burn victim and on failing being told it doesn’t get any worse than this. No matter how much time you spend in clinic there are always going be surprises. Especially when you think it cannot get any worse, something will come in and take that place. I’ve seen some horrific things, sometimes enough that I wonder if I sleep if I will get nightmares.

The scary thing is however that a lot of horrific things are also extremely cool. Today was one of those horrific things that was also amazingly cool.

Cool because the kitten was alive. Cool because the kitten was ok neurologically. And cool because it was not something that you will see every day. Actually not sure when you would see it at all.

Now these are where the skills that cannot be taught in the classroom really are tested. I like a challenge, and this is definitely that. When the discussion you are having is whether what you are looking at is skull or dura (the covering of the brain).

Yes. There is a kitten running around. Playing. Drinking. With a great massive hole in its head.

So now to do something? I’ve spent hours and hours in textbooks and cannot find a single mention of what to do. We’ve not got CT or MRI. I so wish we did so that we knew what it was, and what was underneath.

Is there a brain abscess? Dunno… Maybe.

So kitten is scheduled in for cleaning of the wound. And then maybe we will know more.

A permanent solution to a temporary problem, suicide, perfectionists, and failure (Day -284)

Suicide. Death. The End. Is it an escape? Or being let down?

There was a meme that went round recently of a Dr leaving a consultation room after telling a family their son had died. It was captioned: only one of these people is going back to work today.

Now consider this:

Vets are 4x more likely than the general population, and 2x more likely than those in health care professions to die by suicide (UK study Bartram et al, 2010).

Nearly 1/10 US veterinarians suffer severe psychological distress, and 1/6 have had suicidal thoughts since graduation (CDC Notes, 2014).

Last week 2 vets committed suicide (that I know about).

We want the best vets possible so select the highest achieving perfectionist straight A students there are, push them through the toughest school there is, and put them into a profession where they will fail.

Why fail? Animals will die. No matter how good you are there will be animals you cannot save. Animals that owners decide are too much work or too big for their flat so have you euthanise. Animals that you do everything you know how to save that just die. Animals where owners cannot afford the treatment you want.

And then there are the questions you ask yourself. The questions that keep you from sleep at night. What else could I do better? What could I do different? Could I save that animal?

The next day it repeats. The next week it repeats. These people that have succeeded at everything they have ever done are failing. Nature is beating them in the battle of life.

Then there are owners. Who demand the world for nothing. And then blame the vet when they lose.

Could it actually get worse?

Now there is an even bigger potential problem with social media causing the suicide of vets through cyberbullying. Not by their patients, or owners that they have worked with. Complete strangers that have a single side of the story that judge them.

I saw it on Facebook  last night – a owner posting about making complaints to a vet after their pet died and getting cheered on by people that knew nothing about the backstory – a quick search of the group showed that the owner posted a few days earlier about their pet not eating for several days before they went to the vet…

Yet it is the vets fault the animal died. This perfectionist that tried to fix a problem compounded by the owners delay in seeking treatment who failed. Now judged publically as a failure by people they do not even know.

Is it a problem? Is the suicide rate going go up as cyberbullying increases?

There have been changes, there are people getting involved to reach out and help people who ask for their help. In the UK we have the excellent vetlife helpline which is there for vets in need.

Something that has always confused me is that we are really good at expecting people to come to us. We tend to be reactive rather than proactive. This is what I think the next step in reducing the number of suicides will be. Some kind of proactive system for monitoring the mental health of vets.

Actually around midnight last night I came up with an idea that I am going work on over the next month or so that I hope may be able to do this. I will keep you updated.

Inside the eye (Day -285)

Today I have been helping out on an Ophthalmology conference with an international expert on animal eyes, Professor Ron Ofri. Eye problems are something seen daily – yet can be extremely serious so I believe learning as much as I can about them is a good idea.

It was arranged to be accessible with stuff that can be taken into practice straight away, and through the day there was a focus on what as vets we can do. Some of it is simple such as testing if a cat is blind by following laser light (though have to be careful it is not a cat with a god complex!). There was only one surgery lecture and it was good revision – something they do teach really well at this university is surgery of the eye and eyelid!

One of the more interesting lectures for me was that of whether animals can see in color. It is a rather interesting question actually as a lot of people assume that animals can see, yet never question just how well they can see.

The question put forward was which of these have the best and worst sight: dog, horse or cat?

Surprisingly the answer was that the horse has the best sight, with the dog in the middle and then the cat with the worst sight.

Also interesting here is when you consider the field of vision. Imagine if you stand next to a horses head looking forward – you can see what is in front of you… yet the horse can see this, see you, and see what is behind you!

I completed my ophthalmology modules within uni last year– however one thing missed from this was instruction on how to use an ophthalmoscope. This was something that an exhibitor at the conference corrected with their explanations and demonstrations of several different types of ophthalmoscopes. This was made very interesting as he had in the past persuaded a person that modelled human eyes for ophthalmologists to practice on to make him some animal eyes with different pupil dilations.