I have been doing this for a little while; at a conservative estimate, I have carried out more than 60,000 consultations during my career.
Sixty thousand. That makes me feel a little strange (and a lot old).
For the majority of my time in practice, my allotted consulting time has been 10 minutes. Sixty-thousand 10-minute slots of my life – more than a year of continuous consultation without so much as a break to go for a pee.
It’s strange, then, I feel like I have barely started seeing all the possible variations. I still have so much to learn.
No two the same
Sixty thousand consultations. Every one of them a story, and every one different. I try to break them down in my head; to think of the themes that stick in my mind, and maybe to see if there’s a conclusion I can draw from it all. Tens of thousands of vaccinations, from excited new owners with lists of questions about their new puppy or kitten, to injections of aged, slowing companions, with discussions about whether this will be the final time.
Thousands upon thousands of cat bite abscesses, each one a variation on a theme – legs, heads, painful, painful tails. Abscesses that got better almost without effort, abscesses that resisted all attempts. Abscesses that burst in the consulting room, eliciting gasps or laughter or, on one occasion, vomiting (owner, not pet).
Abscesses that entered joints. Pyothoraxes. All those cats, all those organisms, and all those owners. Owners who were dreadfully worried, owners who were frustrated because this was the fourth time their cat had got bitten, owners who had been sent by their spouses and didn’t really like cats. Not a single case the same. At university, I learned the details of Key-Gaskell syndrome, and myasthenia gravis, but not once did anyone tell me the best thing to do with a cat bite abscess.
I’ve seen countless thousands of skin disease cases, from young dogs showing their first signs of atopy – and explaining to the owners this may be the start of a very long road – to aged, elephantine-skinned, long-suffering patients, with long consultations exploring whether I had anything left to offer.
Sort it – today…
As I try to categorise all these consultations into types, I find my absolute least favourite is the one I am slotting into the “I’ve seen five different vets with this skin disease, and nothing has worked. I want it sorted – today” folder. Not because I don’t understand the owner’s frustration, but because I do – and because it is not something that can be rushed through in 10 minutes.
These are long, patient and frustrating consultations for vets and owners, and any other vets consulting who have to pick up the slack as the waiting room fills up. It was consultations about canine skin disease that first made me wonder, all those years ago, why we were inbreeding dogs to such an extent that the majority of these consultations were with a small handful of breeds, and seeing their suffering over their lifetimes first hand made me start to question the healthiness of pedigree breeds.
Euthanasias – deaths beyond count, the final story of all the different stories for my patients, and “the hardest part of the job”. Actually, I never found that to be true, because so many different and difficult aspects exist to our work. Many times, the decision leading to it was much harder than the actual procedure, for both myself and the owners.
Nevertheless, I have never quite got used to the killing, and am certainly not comfortable with it, even though I am completely happy it was the right thing to do in the vast majority of those thousands of cases (and try not to think about the few where it wasn’t). Paradoxically, I started to find it more difficult later in my career, when I was less worried about the technicalities, and had more time to think about what I was actually doing.
So many different consultations. Older dogs with near-panicked owners because of vestibular syndrome, and the hundreds of times I tried to persuade the owners to wait 24 hours before rushing into a decision (not always successfully).
Non-specifically unwell cats, when I have felt a huge abdominal mass within seconds of starting the consultation, but try to find a way to tactfully explain my concerns to the owners, instead of blurting it out before they have even finished telling me what’s wrong. Common diseases with hundreds of variations: kennel cough, cat flu, cruciate disease, impacted anal glands.
Thousands of cancers, from histiocytomas and anal adenomas to osteosarcomas and squamous cell carcinomas. Rarer diseases, memorable by their scarcity: eosinophilic bronchopneumonitis, atypical hypocortisolaemia, leishmaniosis (rare in this country, at least), and yes, myasthenia gravis.
Most of the clients I’ve seen have been wonderful, caring people, and a small minority of them… less so. Human nature being what it is, it’s the minority that sticks in my mind.
My consulting room has seen most of my emotions – I’ve pontificated, and philosophised, and tried to explain the art of the job to vet students. I’ve laughed and cried, and, on occasion, have felt something snap in my mind and be convinced that I couldn’t continue for another second. I have drunk a lot of coffee.
All of this, and every bit of it squeezed into one of those 60,000 10-minute slots. Mulling it all over, there’s only one theme that is apparent, and only one conclusion I can draw from it all – it’s a thought both wonderful and terrifying: I never saw the same thing twice. I never will.
I still have so much to learn.