I distinctly remember my first encounter with the world of emergency medicine. It was when I called the local emergency center for advice on how to manage a patient that was bitten by venomous snake. I was blown away by the calm, knowledgeable and reassuring voice on the other end of the phone. I put the phone down reassured and thought to myself that I would like to be that person someday. I was so grateful to that emergency clinician and little did I know that she was to become one of my mentors and have a huge impact on my career.
When I graduated from vet school, I was not aware that the field of emergency and critical care existed. My first two years were spent in a busy small animal practice where I had great support and mentorship. My decision to turn to the dark side (i.e. emergency medicine) was based on a number of unfortunate circumstances. I was in the position where I could not afford my mortgage and required more money otherwise I would have to sell my house. My intentions were that it was only going to be a temporary career shift. I did not expect to still be an emergency and critical care veterinarian to this day.
When I first thought about working in emergency I was somewhat expecting quiet nights. Perhaps a couple simple cases, nothing too crazy. Boy was I in for a shock! I recall a night in the first couple months where I had three critical emergency patients come in quick succession. The first was run over by a car, the next ran in front of a bus, the last was, unbelievably, hit by a bicycle! I almost expected the next patient to be hit by a meteorite or plane!! It was a challenging night; these patients had varying degrees of injuries, ranging from head trauma, pulmonary contusions, fractures, lacerations and abrasions. It was an overwhelming and stressful experience as each patient required different levels of intensive management and care. Due to my prompt interventions all three patients survived their encounters. I soon discovered that this fast paced and unpredictable environment is the nature and the lure of emergency for me.
Having being an emergency veterinarian for several years, the things that I found intimidating at the start, I now find exciting and rewarding.
One of the most intimidating aspects is the unknown. There are no set appointments; patients arrive in various degrees of illness. Often what starts as a quiet night can become mayhem in a matter of minutes. There is rarely a dull moment. This unknown element/nature of emergency veterinary practice is what I find enticing.
I am there for the pets and their families when they have nowhere else to go. I am also there to support my fellow veterinarians in their time of need; every shift I talk to general practitioners who need advice and support regarding emergency or critically ill patients. When necessary, I take on the responsibility of these very ill patients, and see it as my responsibility to do my best to get them home to their families.
Frequently the patients we see are critically ill and unstable. In order to save the lives of these patients, immediate intervention and intensive care is often required. I have realised that I need to trust my knowledge, experience and gut instincts to make the call on what to do. A frequent scenario I face is when a patient presents in shock and requires immediate triage and stabilisation. The big unknown is - what form of shock is it? Is it shock due to a failing heart or from an internal bleed? Fluid therapy can be lifesaving for one type but deadly for the other. This pressure can be paralysing. With time and mentorship, it becomes second nature. Before long, and without realising, what was initially stressful becomes a source satisfaction.
Emergency veterinarians are exposed to a wide gamut of issues, and often the sickest of the sick. Given that specialists are often unavailable at 1am, it is essential that I became skilled and knowledgeable in many different areas. One example is that I had to become proficient at ultrasonography, as often there is no one else but me to perform them. This took several years and hundreds of patients, and this skill has become incredibly useful. However a pet is presented to us, it is my role as an emergency veterinarian to be able to treat them. This pressure makes me want to continually strive to learn and keep up to date with advancements in medical care. At times, despite my best efforts, knowledge and training, not all patients can be saved. From these cases I ask myself, what can I learn from this situation and how can it help me save my next patient?
It goes without saying that working longs shifts and nights in a high pressure environment can take its toll on the body, mind and soul. I found the balance difficult to achieve when I first started. I would not be able to sleep despite being bone tired. I would wake at random hours of the morning with my mind just ticking away - this highlighted the importance of investing in my health and well-being. Exercising is a priority for me as it helps me unwind and enables my body to cope with the physical demands of this nature of shift work. As the saying goes “time flies when you are having fun” and it is not uncommon for me to be in the clinic for 16 hours not realising where the time went. I see this now as a sign that I have chosen the right career path for me after all.
Sometimes patients cannot be saved not matter how much I try. Sometimes I wonder if my passion for emergency medicine and my commitment to caring for animals is enough to keep me going. And of course there are times when I would rather be somewhere else. It is in those times, I try to create for myself a reason that inspires me to be there. My most frequent choice is contribution. I can see the positive impact I have on my patients, their families and the people I work with.
Seeing a pet that was critically ill being reunited with their families and the relief and gratitude they share, helps me make it through the long and stressful shifts. I also cherish the privilege of being a contribution to my colleagues and assisting them in the amazing work they do. Being an emergency veterinarian is definitely not the easiest or most comfortable profession I could have chosen, but I cannot imagine myself doing anything else.
I think back to when I was on the receiving end of that calm reassuring voice, and I find it hugely rewarding that now, I am that reassuring voice to other veterinarians.