Friday, May 4, 2012

I love my job!

As you probably have seen from reading my blog, my job can be very stressful, sometimes infuriating, and often exhausting.  Working overnights, 15+ hours at a time, and in emotionally charged situations is exceptionally difficult.  It takes a specific personality, and a specific person to be able to work this job in the long term.

Despite all this, I love my job.  I have the best employers anyone could ask for.  I work with amazing colleagues and support staff.  I have the equipment, tests, drugs, and supplies that I need to do my job every day.  This all may seem like no big deal, but I can tell you that a great portion of my classmates, friends and colleagues struggle with the above on a daily basis.  Furthermore, I have worked hard throughout veterinary school and my internship that I truly feel that I am good at what I do. Of course, I don't know everything - but I know enough to realize that I'm in the right career as an emergency doctor.

A case this week reminded me of how amazing my job really is.

"Glenda," a 5 year old great dane, presented to my hospital for bloat. (See previous posts for a description of bloat, or read here).  Her family had come home to find her in this condition, so she had been bloated for an unknown portion of time.  They gave permission to treat aggressively and proceed with surgery.  She was stabilized with fluids, give pain medications, antibiotics, and we prepared to place her under general anesthesia.

Glenda's vitals, BP, ECG, and all other parameters remained stable and normal under anesthesia.  Despite this, she suffered from several complications of GDV surgery; she refluxed gastrointestinal contents (unfortunately, the dilated stomach contents can spill into the esophagus and possibly be aspirated despite precautions of a tube in the trachea), and she seemed to ooze blood excessively. I untwisted her stomach, performed a gastropexy so she could not suffer a GDV in the future, and also removed a large piece of bone from her stomach.  When her laboratory values returned, I noted that her platelet count was low, as well as her albumin, a very important protein involved in healing.  She also had a low white blood cell count, probably due to bacteria spreading into her blood stream from the compromise tissues (known as bacterial translocation).  

Over the next day, Glenda also suffered from ventricular arrhythmias, a common complication associated with surgery of this type.  In total, Glenda was probably suffering from SIRS - or systemic inflammatory response syndrome.  This is poorly characterized in veterinary medicine, but results in patients with systemic illness, such as GDV, and sends whole cascades of inflammatory mediators, cell signals, and clotting cascades on a crash course towards disaster.  There is no specific therapy for SIRS, other than supportive care, nutrition, and correction of the underlying cause (which I had done in surgery).

Over the next few days, Glenda was treated with lidocaine (to stop her cardiac arrhythmias), IV fluids, hetastarch (to support her low proteins), antibiotics (to treat the suspected sepsis, or blood infection), pain medication, and she was provided nutrition through a tube into her esophagus.  Her blood pressure, ECG, vitals, comfort, attitude, appetite and physical exam were rechecked constantly.  She improved gradually and by the second day, she was significantly stronger and eating on her own.  

With careful attention to detail, constant observation, expert technicians, and knowledge of complicated physiology and pathology of Glenda's condition, we were able to pull her back from the brink of death.  She went home to her happy family 3 days after surgery, and is expected to make a full recovery!